Laparoskopisches Training mit einem Computer-Simulator-System: Auswirkung auf die Lernkurve

Abstract

Zusammenfassung. Grundlagen: Wir untersuchten den Effekt des ,,virtual reality (VR) laparoscopy simulator (LapSim + )'' auf die Lernkurve bei laparoskopischer Chirurgie.Methodik: 14 Medizinstudenten wurden fü r ,,clip application'' randomisiert. Gruppe A (n ¼ 7) niedriger Schwierigkeitsgrad, Gruppe B (n ¼ 7) hoher Schwierigkeitsgrad. Beide Gruppen wurden nach 2 Monaten wieder getestet, entsprechend dem Schwierigkeitsgrad. Bei jedem Training am Simulator musste die Ü bung 10Â wiederholt werden.Ergebnisse: Beide Gruppen verbesserten sich im Vergleich zur ersten Trainingseinheit. Gruppe A hat das 2 Training schneller und blutä rmer beendet als Gruppe B. LernkurvenPlateau war in Gruppe A nach 6 Wiederholungen erreicht, solches war bei Gruppe B nicht zu beobachten.Schlussfolgerungen: Die Lernkurve scheint eher von der Schwierigkeit der Ü bung als von der Anzahl der Wiederholungen abhä ngig zu sein.Schlü sselwö rter: Computer-Simulation, Laparoskopie, chirurgische Ausbildung, minimal invasive Chirurgie.Summary. Background: The aim of this study was to determine the influence of different training levels with increasing complexity on the learning curve of a virtual reality (VR) laparoscopy simulator (LapSim + ). Furthermore, this study was designed to identify reacquisition of performance in medical students.Methods: 14 medical students in their final year without previous laparoscopic experience were randomized into two groups, both of which performed the ''clip application'' task.Group A (n ¼ 7) had parameter adjusted to an easy level of performance, while group B (n ¼ 7) was adjusted to a difficult level. Both groups were tested again at their respective level two months later. During both training sessions, each participant had to repeat the task ten times consecutively.Results: Both groups had improved parameter of performance when tested again after two months. Group A completed the second training session significantly faster than Group B and with less loss of blood. Parameter of performance plateaued in group A by the 6th repetition. However, such stable plateau was not reached in group B.Conclusions: This result suggests that steepness and plateau of a learning curve may be more dependent on the level of performance required by the particular training session rather than the number of repetitions during a session.

The LapSim virtual reality simulator: promising but not yet proven

“…Other groups have attempted to establish learning curves for clip application [31,32,51], grasping [32], lifting and grasping [31], cutting [31,32], and salphingectomy [31,52], but standardized curves for all the tasks of the LapSim are yet to be defined. Certainly, it seems that learning curves are dependent on the complexity of the task and the level of performance required.…”

Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review

“…The studies included first year to sixth year medical students and were published between 2001 and 2020. In terms of the topic or area of study, 53% (34/64) of the studies focused on laparoscopic surgery [ 22 , 24 , 27 , 31 , 35 - 38 , 40 , 41 , 45 - 48 , 50 - 52 , 54 , 56 - 66 , 69 , 78 , 81 - 83 ]; 16% (10/64) on surgery [ 25 , 28 , 53 , 55 , 67 , 68 , 71 , 74 , 76 , 77 ]; 8% (5/64) on orthopedic surgery [ 39 , 42 , 73 , 79 , 84 ]; 8% (5/64) on ureteroscopy [ 30 , 33 , 34 , 80 , 85 ]; 5% (3/64) each on ophthalmology [ 26 , 70 , 75 ] and intravenous cannulation [ 29 , 32 , 72 ], and 2% (1/64) each on endoscopy [ 49 ], colonoscopy [ 23 ], shoulder-joint clinical anatomy [ 44 ], and empathic communication skills [ 43 ].…”

Training in minimally invasive surgery in urology: European Association of Urology/International Consultation of Urological Diseases consultation

“…Increased task complexity resulted in prolonged training time. Nevertheless, the overall skill outcome was improved in the case of complex tasks . Training in conditions resembling those of clinical practice such as stress, noise, altered visual dynamics or working against the camera was associated with improved task performance .…”