输尿管镜虚拟模拟器在输尿管软镜训练中的作用

摘要

目的：明确输尿管镜虚拟模拟器在输尿管软镜训练中的作用，是否能缩短初学者掌握输尿管软镜的学习曲线及帮助缩短操作者手术时间以及降低医源性手术损伤。方法对本单位16名从未有输尿管镜实践的硕士研究生用输尿管虚拟模拟器测试模块进行评估，然后对其再进行为期1个月的输尿管模拟器训练，训练结束时进行复评。同时选取符合入选标准的本单位进修泌尿外科医师16名，使用相同模块进行评估和复评，两次间隔1个月，而进修泌尿外科医师不接受额外的模拟器练习。比较两组初评及复评时完成模块的时间、曝光时间、尿路上皮损伤情况、GRS评分。结果研究生完成测试模块的时间从17.4 min缩短到8.7 min，曝光的时间从33.2 s缩短到14.3 s，平均尿路上皮损伤例数从0.6例减少到0.1例，每项GRS评分均有不同程度的提高(P<0.01)。研究生经过1个月模拟器训练后完成测试模块曝光时间的尿路上皮损伤例数均少于泌尿外科医师，差异有统计学意义(P<0.01)，GRS评分方面除了动作的熟练程度差异无统计学意义（P>0.05），其他四个方面均差于泌尿外科医师(P<0.01)。结论研究生在经过输尿管镜虚拟模拟器培训后能够提高完成任务的时间将近50%，减少曝光的时间，减少医源性损伤。虚拟模拟器训练可以让初学者缩短学习曲线。%Objective To investigate the role of virtual reality simulators in the training of flexible-ureterosco-py, to determine whether it can shorten operative time, reduce the potential iatrogenic injury by providing training out-side the operating room, and allow novice to overcome the initial learning curve of flexible-ureteroscopy. Methods We evaluated 16 medical masters who lack endoscopic surgery experience on their ability to perform test module on a VU simulator. The masters trained on the simulator for one month using different training modules, then retested on the ini-tial module. Likewise, 16 urologyical surgeons with varying degrees of endoscopic experience were assessed on the same test module twice, without additional simulator training. The task completion time, exposure time, urinary epithe-lial damage, global rating scale (GRS) score at initial test and second test were compared. Results The masters im-proved the task completion time from 17.4 min to 8.7 min, reduce exposure time from 33.2 s to 14.3 s, reduce the aver-age cases of urinary epithelial damage from 0.6 to 0.1, but the GRS score increased to varying degrees at the second test, P<0.01. At the second test, the masters has significantly less exposure time and urinary epithelial than the urologyical surgeons (P<0.01), while GRS score were significantly worse except for action proficiency (P<0.01). Conclusion Nov-ice medical masters trained on a VU simulator improves task completion time by 50%after training, and also reduces exposure time and the iatrogenic injury. Virtual-reality simulator training may allow the novices to shorten the initial learning curve associated with ureteroscopy training, although this hypothesis requires further validation.