PDF(Pubmed)
Abstract：
Selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS) is challenging for new surgeons at the start of their learning curve. We described an approach utilising telementoring and team-based training to facilitate rapid attainment of the skills required for safe and efficient practice with a limited caseload.
We conducted a prospective observational study of SFLP performed by the novice primary surgical team in three stages: under direct on-site supervision from an expert mentor (Group 1), with remote tele-guidance from that mentor (Group 2) and independently (Group 3), at an academic tertiary hospital in Singapore. The primary team undertook regular training on high-fidelity tissue models to accelerate skills acquisition and complement the surgical performance.
9 patients diagnosed with Stage 2 TTTS were assessed for procedural characteristics, surgical outcomes and perinatal survival following SFLP. There were no significant differences in operative duration, anastomoses ablated, gestational age or birth weight at delivery. The complications observed were: recurrent TTTS (22.2% of pregnancies), twin anaemia polycythaemia sequence (33.3%), preterm prelabour membrane rupture (22.2%) and delivery at < 32 weeks (44.4%). ≥ 1 twin was live-born in 88.9% of cases, while postnatal survival to six months of ≥ 1 twin occurred in 77.8% of cases.
Systematic mentoring and specialised skills training are useful in aiding new surgeons to negotiate the steep learning curve and achieve good outcomes at the start of a new practice, particularly in the setting of low patient numbers. This is best paired with dedicated model training to achieve and maintain surgical dexterity for this complex procedure.
We conducted a prospective observational study of SFLP performed by the novice primary surgical team in three stages: under direct on-site supervision from an expert mentor (Group 1), with remote tele-guidance from that mentor (Group 2) and independently (Group 3), at an academic tertiary hospital in Singapore. The primary team undertook regular training on high-fidelity tissue models to accelerate skills acquisition and complement the surgical performance.
9 patients diagnosed with Stage 2 TTTS were assessed for procedural characteristics, surgical outcomes and perinatal survival following SFLP. There were no significant differences in operative duration, anastomoses ablated, gestational age or birth weight at delivery. The complications observed were: recurrent TTTS (22.2% of pregnancies), twin anaemia polycythaemia sequence (33.3%), preterm prelabour membrane rupture (22.2%) and delivery at < 32 weeks (44.4%). ≥ 1 twin was live-born in 88.9% of cases, while postnatal survival to six months of ≥ 1 twin occurred in 77.8% of cases.
Systematic mentoring and specialised skills training are useful in aiding new surgeons to negotiate the steep learning curve and achieve good outcomes at the start of a new practice, particularly in the setting of low patient numbers. This is best paired with dedicated model training to achieve and maintain surgical dexterity for this complex procedure.
摘要：
选择性胎儿镜下激光光凝（SFLP）治疗双胎输血综合征（TTTS）对于新的外科医生在学习曲线开始时具有挑战性。我们描述了一种利用远程培训和基于团队的培训的方法，以促进在有限的案例中快速获得安全有效的实践所需的技能。
我们对初级外科新手团队进行的SFLP进行了一项前瞻性观察性研究，分三个阶段：在专家导师的直接现场监督下（第1组），在该导师(第2组)和独立(第3组)的远程远程指导下，在新加坡的一家三级医院。主要团队对高保真组织模型进行了定期培训，以加速技能获取并补充手术表现。
对9例诊断为2期TTTS的患者进行手术特征评估，SFLP后的手术结局和围产期生存率。手术时间无显著差异,吻合口消融,分娩时的胎龄或出生体重。观察到的并发症是：复发性TTTS（22.2％的妊娠），双胎贫血红细胞增多症序列(33.3%)，早产胎膜破裂（22.2%）和<32周分娩（44.4%）。在88.9%的病例中，≥1对双胞胎是活产的，77.8%的病例发生≥1双胎的产后存活至6个月。
系统的指导和专业技能培训有助于帮助新外科医生在新实践开始时协商陡峭的学习曲线并取得良好的结果。特别是在低患者人数的背景下。这最好与专门的模型训练配对，以实现和保持这种复杂程序的手术灵活性。
我们对初级外科新手团队进行的SFLP进行了一项前瞻性观察性研究，分三个阶段：在专家导师的直接现场监督下（第1组），在该导师(第2组)和独立(第3组)的远程远程指导下，在新加坡的一家三级医院。主要团队对高保真组织模型进行了定期培训，以加速技能获取并补充手术表现。
对9例诊断为2期TTTS的患者进行手术特征评估，SFLP后的手术结局和围产期生存率。手术时间无显著差异,吻合口消融,分娩时的胎龄或出生体重。观察到的并发症是：复发性TTTS（22.2％的妊娠），双胎贫血红细胞增多症序列(33.3%)，早产胎膜破裂（22.2%）和<32周分娩（44.4%）。在88.9%的病例中，≥1对双胞胎是活产的，77.8%的病例发生≥1双胎的产后存活至6个月。
系统的指导和专业技能培训有助于帮助新外科医生在新实践开始时协商陡峭的学习曲线并取得良好的结果。特别是在低患者人数的背景下。这最好与专门的模型训练配对，以实现和保持这种复杂程序的手术灵活性。
