| 摘要: |
| 目的 评估阶梯式培训模式在机器人前列腺癌根治术中的作用及临床意义。方法 采用机器人前列腺癌根治术的阶梯式培训模式,以提高手术团队的操作技能和配合默契度。该培训模式分为4个阶段:第1阶段为模型训练,通过剥葡萄皮、穿线、拾豆、剪纸让参训者充分熟悉机器人的器械及应用；第2阶段为活体动物实验,参训者采用未阉割的雄性狗(年龄5岁,体质量20～22 kg)行机器人腹腔镜前列腺切除术,充分体验和熟悉机器人腹腔镜前列腺切除术的手术过程及关键技术的应用,并磨合手术团队；第3阶段为研讨学习,将接受了第1阶段和第2阶段训练的团队成员分成两组,各自组织助手及器械护士观看经典手术视频,研讨手术步骤、解剖要点、配合技巧,将手术步骤标准化；第4阶段为临床实践,选择合适病例行机器人腹腔镜前列腺癌根治术,并在手术当晚,集合团队成员对手术视频进行分析、总结,提出改进意见。结果 通过阶梯式培训,我们在10个月内行机器人腹腔镜前列腺癌根治术20例,手术时间从第1例的300 min缩短到第20例的150 min,平均手术时间185 min,平均出血量为160 mL。手术均顺利进行,无一例中转开放,无术中并发症。4个阶段总培训时间约为10个月。结论 通过机器人前列腺癌根治术的阶梯式培训模式进行团队整体培训,可以大大缩短学习曲线,提高手术成功率,减少手术并发症的发生。 |
| 关键词: 前列腺肿瘤 机器人 腹腔镜检查 前列腺根治术 培训模式 |
| DOI： |
| 投稿时间：2013-03-13修订日期：2013-06-06 |
| 基金项目: |
|
| Value of step-step training model in team training of robot-assisted laparoscopic radical prostatectomy |
| GUO Fei△,YANG Bo△,WANG Hui-qing,XU Chuan-liang,GAO Xu,WANG Lin-hui,XIAO Liang,SHENG Xia,WANG Li-li,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To assess the efficacy and clinical significance of the step-step training model in team training of robot-assisted laparoscopic radical prostatectomy. Methods The step-step training model was applied in team training for robot-assisted laparoscopic radical prostatectomy to improve the operating skills and team collaboration. The step-step training model was divided into four stages. The first stage was model training, in which the surgeons became familiar with the da Vinci Surgical System through passing needle, picking up beans, cutting paper, and peeling grape skins. The second stage was live animal experiment, in which robot-assisted laparoscopic prostatectomy was performed on male dogs not castrated (5 years old, weighing 20-22 kg), allowing the surgeons to become familiar with the procedure of robot-assisted laparoscopic prostatectomy and the key techniques. The third stage was learning based on discussion, in which the trainees were divided into two groups; each group watched the classical operation videos of robot-assisted laparoscopic prostatectomy, and then discussed the operation procedure, anatomical key points, collaboration skills so as to standardize the surgical procedure. The fourth stage was clinical practice, in which patients were chosen for robot-assisted laparoscopic prostatectomy, and the operation team watched the operation video and made discussion, summarization and put forward improving advice at the very night of operation. Results We finished 20 cases of robot-assisted laparoscopic prostatectomy within 10 months by step-step training model. The operation time was reduced from 300 min for the first case to 150 min for the twentieth case, with the average operation time being 185 min. The mean blood loss was 160 mL. The surgeries were all successful without complications or converting to open surgery. The 4 stage training took about 10 months. Conclusion Our step-step training model for team training can shorten the learning curve, improve the success rates, and reduce the complications of robot-assisted laparoscopic prostatectomy. |
| Key words: prostatic neoplasms robotics laparoscopy radical prostatectomy training model |
