Simulator training in fetoscopic laser surgery for twin-twin transfusion syndrome: a pilot randomized controlled trial
Simulator training in fetoscopic laser surgery for twin-twin transfusion syndrome: a pilot randomized controlled trial
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DOI：
10.1002/uog.14916
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发表时间：
2015-09-01
影响因子：
7.1
通讯作者：
Oepkes, D.
中科院分区：
文献类型：
--
作者：
Peeters, S. H. P.;Akkermans, J.;Oepkes, D.
目的 使用先进的高保真模拟器模型评估新开发的培训课程对双胎输血综合征 (TTTS) 胎儿镜激光手术表现的影响。方法 10 名新手随机接受口头指导并使用模拟器进行技能培训（研究组；n = 5）或不接受培训（对照组；n = 5）。两组均在模拟器上进行训练前和训练后测试进行评估。表现由两名独立观察员进行评估，并包含 52 项检查表，包括手术表现 (SP) 评分、手术时间测量和遗漏吻合术数量。十一位专家设定了性能基准水平。通过问卷评估模拟器的面部效度和教育价值。结果与训练前测试相比，两组在训练后测试中的 SP 分数均有所提高。模拟器训练组的表现显着优于对照组，前测 SP 得分为 28 分（54%），后测 SP 得分为 46 分（88%），而后测 SP 得分中位数分别为 25 分（48%）和 36 分（69%）（P=0.008）。研究组的手术时间减少了 11 分钟（从 44 分钟减少到 33 分钟），而对照组则减少了 1 分钟（从 39 分钟减少到 38 分钟）（P=0.69）。两组之间训练后测试中漏吻合的数量没有显着差异（1 vs 0）。参与者随后提供的反馈表明，模拟器培训被认为是一项有用的教育活动。 结论 基于熟练程度的模拟器培训提高了胎儿镜激光治疗的表现（SP 评分表明）。尽管这项研究的样本量较小，但建议学员在对孕妇进行 TTTS 激光治疗之前先在模拟器上进行练习。版权所有 (C) 2015 ISUOG。由约翰·威利父子有限公司出版
Objective To evaluate the effect of a newly developed training curriculum on the performance of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS) using an advanced high-fidelity simulator model.Methods Ten novices were randomized to receive verbal instructions and either skills training using the simulator (study group; n= 5) or no training (control group; n= 5). Both groups were evaluated with a pre-training and post-training test on the simulator. Performance was assessed by two independent observers and comprised a 52-item checklist for surgical performance (SP) score, measurement of procedure time and number of anastomoses missed. Eleven experts set the benchmark level of performance. Face validity and educational value of the simulator were assessed using a questionnaire.Results Both groups showed an improvement in SP score at the post-training test compared with the pre-training test. The simulator-trained group significantly outperformed the control group, with a median SP score of 28 (54%) in the pre-test and 46 (88%) in the post-test vs 25 (48%) and 36 (69%), respectively (P= 0.008). Procedure time decreased by 11 min (from 44 to 33 min) in the study group vs 1 min (from 39 to 38 min) in the control group (P= 0.69). There was no significant difference in the number of missed anastomoses at the post-training test between the two groups (1 vs 0). Subsequent feedback provided by the participants indicated that training on the simulator was perceived as a useful educational activity.Conclusions Proficiency-based simulator training improves performance, indicated by SP score, for fetoscopic laser therapy. Despite the small sample size of this study, practice on a simulator is recommended before trainees carry out laser therapy for TTTS in pregnant women. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.