背景:机器人缝合训练的需求不断增加,可以使用缝合垫或机器人模拟训练来完成。机器人仿真不那么麻烦,而机器人缝合垫方法可能更有效,但成本更高。两种方法之间交叉的培训课程可能是一个实用的解决方案。然而,缺乏评估机器人模拟或缝合垫在机器人缝合训练中的影响的研究。
方法:这是一项随机对照交叉试验,由来自3个国家的20名机器人新手进行,他们使用具有SimNow(机器人模拟)和缝合垫(干实验室)的IntuitiveSurgical®X和Xi系统进行了机器人缝合训练。参与者被随机分配到机器人模拟开始(干预组,n=10)或缝合垫(对照组,n=10)。在第一次和第二次训练之后,所有参与者在生物组织中完成了机器人肝空肠吻合术(HJ)。主要终点是HJ期间的客观结构化技术技能评估(OSATS)评分,由两名盲人评分者得分。次要终点是力测量和定性分析。培训后,对参与者的偏好进行了调查.
结果:总体而言,20个机器人新手完成了两个培训课程,并执行了40个机器人HJ。在两次培训之后,OSATS在机器人模拟第一组中得分较高(3.3±0.9vs2.5±0.8;p=0.049),而中位最大力(N)(5.0[3.2-8.0]vs3.8[2.3-12.8];p=0.739)在两组间无显著差异.在调查中,17/20(85%)参与者建议包括机器人模拟训练,14/20(70%)参与者更喜欢从机器人模拟开始,和20/20(100%)包括缝合垫训练。
结论:机器人新手在机器人HJ期间的手术表现在机器人模拟-首先训练,然后进行缝合垫训练后明显更好。包括机器人模拟和干实验室缝合的机器人缝合课程应该从机器人模拟开始。
BACKGROUND: Robotic suturing training is in increasing demand and can be done using suture-pads or robotic simulation training. Robotic simulation is less cumbersome, whereas a robotic suture-pad approach could be more effective but is more costly. A training curriculum with crossover between both approaches may be a practical solution. However, studies assessing the impact of starting with robotic simulation or suture-pads in robotic suturing training are lacking.
METHODS: This was a randomized controlled crossover trial conducted with 20 robotic novices from 3 countries who underwent robotic suturing training using an Intuitive Surgical® X and Xi system with the SimNow (robotic simulation) and suture-pads (dry-lab). Participants were randomized to start with robotic simulation (intervention group, n = 10) or suture-pads (control group, n = 10). After the first and second training, all participants completed a robotic hepaticojejunostomy (HJ) in biotissue. Primary endpoint was the objective structured assessment of technical skill (OSATS) score during HJ, scored by two blinded raters. Secondary endpoints were force measurements and a qualitative analysis. After training, participants were surveyed regarding their preferences.
RESULTS: Overall, 20 robotic novices completed both training sessions and performed 40 robotic HJs. After both trainings, OSATS was scored higher in the robotic simulation-first group (3.3 ± 0.9 vs 2.5 ± 0.8; p = 0.049), whereas the median maximum force (N) (5.0 [3.2-8.0] vs 3.8 [2.3-12.8]; p = 0.739) did not differ significantly between the groups. In the survey, 17/20 (85%) participants recommended to include robotic simulation training, 14/20 (70%) participants preferred to start with robotic simulation, and 20/20 (100%) to include suture-pad training.
CONCLUSIONS: Surgical performance during robotic HJ in robotic novices was significantly better after robotic simulation-first training followed by suture-pad training. A robotic suturing curriculum including both robotic simulation and dry-lab suturing should ideally start with robotic simulation.