Abstract：
BACKGROUND: Simulation and video-based assessment (VBA) offer residents the opportunity to develop operative skills while ensuring patient safety. This study aims to determine whether simulation training can predict residents\' operative performance, focusing on the gastrojejunal (GJ) anastomosis during robotic pancreatoduodenectomy.
METHODS: Twenty-seven general surgery residents completed simulated robotic GJ drills and subsequently performed GJs in the operating room (OR). Both simulated and intraoperative performances were video recorded and retrospectively assessed by two blinded graders using the Objective Structural Assessment of Technical Skills (OSATS) scale, time to completion, and occurrence of errors. Intraoperative GJ OSATS scores were compared in cases with and without Clinically Relevant Delayed Gastric Emptying (CRDGE). Statistical analysis was performed using Spearman\'s rho, Chi-square, and Kruskal-Wallis tests.
RESULTS: For simulated GJs, the median OSATS score was 29 (IQR 27-33), time to completion was 30 min (IQR 27-35), and 11 cases had at least one error. Intraoperative GJs had a median OSATS of 30 (IQR 27-31), time to completion of 41 min (IQR 36-51), and errors occurred in nine cases. The OSATS score on the simulated GJs demonstrated a significant positive correlation to the OSATS score on the operative GJs (r = 0.74; p < 0.001) and less time to completion (r = - 0.68; p < 0.001). A shorter simulated GJ completion time significantly correlated with a higher intraoperative OSATS score (r = - 0.52; p < 0.01). Residents with at least one error in the simulated GJs had lower OSATS scores and higher times intraoperatively. Those cases with CRDGE had significantly lower intraoperative OSATS scores than those without CRDGE.
CONCLUSIONS: Performance on a simulated robotic GJ environment is a robust predictor of OR GJ performance, demonstrating predictive validity. VBA of residents\' operative GJ performance is associated with the presentation of CRDGE. Simulation-based training may be crucial to optimizing surgical outcomes before operating on patients.
METHODS: Twenty-seven general surgery residents completed simulated robotic GJ drills and subsequently performed GJs in the operating room (OR). Both simulated and intraoperative performances were video recorded and retrospectively assessed by two blinded graders using the Objective Structural Assessment of Technical Skills (OSATS) scale, time to completion, and occurrence of errors. Intraoperative GJ OSATS scores were compared in cases with and without Clinically Relevant Delayed Gastric Emptying (CRDGE). Statistical analysis was performed using Spearman\'s rho, Chi-square, and Kruskal-Wallis tests.
RESULTS: For simulated GJs, the median OSATS score was 29 (IQR 27-33), time to completion was 30 min (IQR 27-35), and 11 cases had at least one error. Intraoperative GJs had a median OSATS of 30 (IQR 27-31), time to completion of 41 min (IQR 36-51), and errors occurred in nine cases. The OSATS score on the simulated GJs demonstrated a significant positive correlation to the OSATS score on the operative GJs (r = 0.74; p < 0.001) and less time to completion (r = - 0.68; p < 0.001). A shorter simulated GJ completion time significantly correlated with a higher intraoperative OSATS score (r = - 0.52; p < 0.01). Residents with at least one error in the simulated GJs had lower OSATS scores and higher times intraoperatively. Those cases with CRDGE had significantly lower intraoperative OSATS scores than those without CRDGE.
CONCLUSIONS: Performance on a simulated robotic GJ environment is a robust predictor of OR GJ performance, demonstrating predictive validity. VBA of residents\' operative GJ performance is associated with the presentation of CRDGE. Simulation-based training may be crucial to optimizing surgical outcomes before operating on patients.
摘要：
背景：模拟和基于视频的评估（VBA）为居民提供了发展手术技能的机会，同时确保患者安全。本研究旨在确定模拟训练是否可以预测居民的手术表现，重点是机器人胰十二指肠切除术中的胃空肠（GJ）吻合。
方法：27名普外科住院医师完成了模拟机器人GJ演练，随后在手术室（OR）进行了GJ。模拟和术中的表现都是视频记录的，并由两名盲人使用客观技术技能结构评估（OSATS）量表进行回顾性评估。时间完成，和错误的发生。在有和没有临床相关胃排空延迟（CRDGE）的情况下，比较了术中GJOSATS评分。使用Spearman'srho进行统计分析，卡方，和Kruskal-Wallis测试.
结果：对于模拟GJ，OSATS评分中位数为29（IQR27-33），完成时间为30分钟(IQR27-35)，11例至少有一个错误。术中GJ的平均OSATS为30（IQR27-31），完成时间41分钟（IQR36-51），9例发生错误。模拟GJ的OSATS评分与手术GJ的OSATS评分呈显著正相关(r=0.74;p<0.001),完成时间较短(r=-0.68;p<0.001)。较短的模拟GJ完成时间与较高的术中OSATS评分显着相关（r=-0.52；p<0.01）。在模拟GJ中至少有一个错误的居民在术中的OSATS得分较低，次数较高。那些有CRDGE的患者术中OSATS评分明显低于没有CRDGE的患者。
结论：在模拟机器人GJ环境中的性能是或GJ性能的可靠预测指标，证明预测有效性。居民手术GJ表现的VBA与CRDGE的呈现相关。基于模拟的培训对于在患者手术前优化手术结果可能至关重要。
方法：27名普外科住院医师完成了模拟机器人GJ演练，随后在手术室（OR）进行了GJ。模拟和术中的表现都是视频记录的，并由两名盲人使用客观技术技能结构评估（OSATS）量表进行回顾性评估。时间完成，和错误的发生。在有和没有临床相关胃排空延迟（CRDGE）的情况下，比较了术中GJOSATS评分。使用Spearman'srho进行统计分析，卡方，和Kruskal-Wallis测试.
结果：对于模拟GJ，OSATS评分中位数为29（IQR27-33），完成时间为30分钟(IQR27-35)，11例至少有一个错误。术中GJ的平均OSATS为30（IQR27-31），完成时间41分钟（IQR36-51），9例发生错误。模拟GJ的OSATS评分与手术GJ的OSATS评分呈显著正相关(r=0.74;p<0.001),完成时间较短(r=-0.68;p<0.001)。较短的模拟GJ完成时间与较高的术中OSATS评分显着相关（r=-0.52；p<0.01）。在模拟GJ中至少有一个错误的居民在术中的OSATS得分较低，次数较高。那些有CRDGE的患者术中OSATS评分明显低于没有CRDGE的患者。
结论：在模拟机器人GJ环境中的性能是或GJ性能的可靠预测指标，证明预测有效性。居民手术GJ表现的VBA与CRDGE的呈现相关。基于模拟的培训对于在患者手术前优化手术结果可能至关重要。
