Using cadaveric simulation to introduce the concept and skills required to start performing transanal total mesorectal excision
Using cadaveric simulation to introduce the concept and skills required to start performing transanal total mesorectal excision
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DOI：
10.1111/codi.14034
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发表时间：
2018-06-01
影响因子：
3.4
通讯作者：
Motson, R. W.
中科院分区：
文献类型：
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作者：
Wynn, G. R.;Austin, R. C. T.;Motson, R. W.
目的的目的是记录外科医生参加尸体模拟课程的结果，旨在提供一个介绍经肛门全直肠系膜切除术（TaTME）。方法这是一个前瞻性的观察性研究，记录课堂和湿实验室活动的结果。随访问卷被用来监测临床活动后，course.Results的结果，来自12个不同国家的65名代表参加7个尸体模拟课程。插入和闭合直肠荷包的中位时间为15 min（范围7-50 min），完成经肛门直肠系膜剥离的中位时间为105 min（范围60-260 min）。标本质量的客观评估显示，42%的标本是完整的，47%的标本几乎是完整的，11%的标本是不完整的。腔内直肠荷包缝合失败是最常见的困难。在参加课程的6个月内，近一半（26/55; 47%）的外科医生进行了1到13次TaTME。只有8/26（31%）的外科医生安排了指导他们的第一个case.Conclusion这种培训模式提供了高水平的学员满意度和知识和技术技能，使他们能够开始执行TaTME。仍有工作要做，以提供足够的监督和指导，为外科医生在他们的学习曲线，这是必不可少的安全引进这项新技术的早期。
Aim The aim was to document the outcomes of surgeons attending a cadaveric simulation course designed to provide an introduction to transanal total mesorectal excision (TaTME).Method This was a prospective observational study documenting the outcomes from classroom and wet lab activities. Follow-up questionnaires were used to monitor clinical activity after the course.Results Outcomes of 65 delegates from 12 different countries attending seven cadaveric simulation courses are described. Median time to insert and close the rectal purse-string was 15 min (range 7-50 min) and median time to complete the transanal mesorectal dissection was 105 min (range 60-260 min). Objective assessment of specimen quality showed that 42% of specimens were complete, 47% nearly complete and 11% were incomplete. Failure of the intraluminal rectal purse-string was the most common difficulty encountered. Within 6 months of attending the course, nearly half (26/55; 47%) of the surgeons who responded had performed between 1 and 13 TaTMEs. Only 8/26 (31%) of the surgeons had arranged mentoring for their first case.Conclusion This training model provides high levels of trainee satisfaction and the knowledge and technical skills to enable them to start performing TaTME. There is still work to do to provide adequate supervision and mentorship for surgeons early on their learning curve that is essential for the safe introduction of this new technique.