切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (02) : 92 -95. doi: 10.3877/cma.j.issn.1674-6899.2020.02.007

所属专题: 文献

论著

单孔腹腔镜体外缝合训练模式的探索
朱方玉1, 罗祎1, 周容1, 刘颖蔚1, 黄琳娟1, 龚瑶1,()   
  1. 1. 400016 重庆医科大学附属第一医院妇产科
  • 收稿日期:2019-12-04 出版日期:2020-04-30
  • 通信作者: 龚瑶
  • 基金资助:
    国家自然科学基金青年基金(81701479)

Exploration of in vitro suture training mode in laparoendoscopic single-site surgery

Fangyu Zhu1, Yi Luo1, Rong Zhou1, Yingwei Liu1, Linjuan Huang1, Yao Gong1,()   

  1. 1. Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
  • Received:2019-12-04 Published:2020-04-30
  • Corresponding author: Yao Gong
  • About author:
    Corresponding author: Gong Yao, Email:
引用本文:

朱方玉, 罗祎, 周容, 刘颖蔚, 黄琳娟, 龚瑶. 单孔腹腔镜体外缝合训练模式的探索[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(02): 92-95.

Fangyu Zhu, Yi Luo, Rong Zhou, Yingwei Liu, Linjuan Huang, Yao Gong. Exploration of in vitro suture training mode in laparoendoscopic single-site surgery[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(02): 92-95.

目的

探索适合体外缝合训练的模拟操作箱、入路平台(port)及缝合方式。

方法

由1位有单孔腹腔镜操作经验的手术医师采用改良腹腔镜模拟训练箱进行缝合操作。缝合方式包括单手法和双手法,缝合目标包括固定目标和活动目标。以不使用port作为对照,比较2种缝合方式在4种不同的port中缝合30针所需的时间。另5位有多孔、无单孔腹腔镜操作经验的医师接受缝合训练,采用无port缝合活动目标,每次训练缝合30针,每周1次,记录分析缝合时间。

结果

采用经改良的常规腹腔镜模拟箱可顺利完成缝合训练。缝合固定目标时,单手法耗时明显少于双手法(P<0.05)。缝合活动目标时,双手法耗时明显少于单手法(P<0.05)。较大port的缝合耗时较久。训练阶段缝合时间前3次逐步缩短[(16.5±0.2)s、(13.4±0.3)s、(12.0±0.1)s](P<0.05),第4、5次[(12.3±0.2)s、(12.3±0.2) s]与第3次比较,差异无统计学意义(P>0.05)。

结论

采用改良的常规腹腔镜模拟操作箱、无需port可完成单孔腹腔镜缝合训练。训练过程需强调单手操作,较大port不适合单孔下的训练,平均3次训练可完成体外缝合的学习曲线。

Objective

To explore an in vitro suture-training mode in laparoendoscopic single-site surgery (LESS) with training box, different access ports and suture modes based on clinical experiences.

Methods

The suture procedure was performed by one experienced surgeon using one-handed and two-handed methods. The suture included a fixed and a mobile target. The time of 30 sutures in 4 ports was compared using the two suture methods and two targets. The control group was suture without port. The followed suture practice was finished by 5 other surgeons without LESS experience once a week without port.

Results

The suture training was successfully completed with a modified conventional laparoscopic training box. When suturing the fixed target, the one-handed method was less time-consuming than the two-handed one (P<0.05). When suturing the mobile target, the two-handed method was less time-consuming than the one-handed one. Suture with a bigger port was more time-consuming. There was no difference in suture time with or without a port. The suture time was gradually shortened in the first 3 times [(16.5±0.2) s, (13.4±0.3) s, (12.0±0.1) s](P<0.05) and there was no statistical difference between the 4th, 5th week and the 3rd week[(12.3±0.2) s, (12.3±0.2) s](P>0.05).

Conclusions

The suture training in LESS could be conducted with a modified conventional laparoscopic training box without port. One-handed suture should be emphasized and a large port is not suitable for training. Practices once a week for 3 weeks would be appropriate for the training.

图1 4 种单孔腹腔镜入路平台(port)
图2 缝合模型及方法
图3 缝合目标和单双手缝合交互作用
图4 入路平台(port)和单双手缝合交互作用
表1 不同因素下缝合时间比较(s,±s)
1
Sandberg EM, Chapelle CF, Tweel MM, et al. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis[J]. Arch Gynecol Obstet,2017,295(5):1089-1103.
2
孙大为. 中国大陆妇科单孔腹腔镜及NOTES手术的探索发展及现状[J/CD]. 中华腔镜外科杂志(电子版),2018,11(1):6-8.
3
温星桥,黄文涛,郑骏明,等. 单孔腹腔镜猪动物训练模型的建立体会[J/CD]. 中华腔镜泌尿外科杂志(电子版),2011,5(1):14-17.
4
李东,冯自卫,冼志勇,等. 泌尿外科单孔腹腔镜技能培训模式的初步探索[J]. 长江大学学报(自然科学版),2011,8(7):208-211,284.
5
叶欣,陆君阳,韩显林,等. 不同培训频率对腹腔镜模拟培训初学者训练效果的影响[J]. 中国微创外科杂志,2017,17(6):553-556.
6
You SH, Huang CY, Su H, et al. The power law of learning in transumbilical single-port laparoscopic subtotal hysterectomy[J]. J Minim Invasive Gynecol, 2018, 25(6):994-1001.
7
李欣,侯纯升,白洋,等. 单孔腹腔镜胆囊切除术的学习曲线:累积求和分析法[J]. 中国微创外科杂志,2016,16(3):241-244.
8
Fukumoto K, Miyajima A, Hattori S, et al. The learning curve of laparoendoscopic single-site adrenalectomy: an analysis of over 100 cases[J]. Surgical Endoscopy,2016,31(1):1-8.
9
Sánchez-Margallo FM, Pérez FJ, Azevedo AM, et al. An analysis of skills acquisition during a training program for experienced laparoscopists in laparoendoscopic single-site surgery[J]. Surgical Innovation,2014,21(3):320-326.
10
孟军,张弋,孙国锋,等. 倒C形打结技术在应用标准腹腔镜器械的单孔腹腔镜培训中的应用[J]. 中国内镜杂志,2015,21(1):30-33.
11
孙义新,吴巍. 数字化单孔腹腔镜模拟操作系统的研制和应用[J]. 现代医学,2012,40(1):81-83.
12
黄琳娟,代雪林,唐均英,等. "三位一体"认识和处理单孔腹腔镜的"筷子效应"[J]. 医学与哲学,2018,39(18):76-77.
13
谢晓峰,朱江帆,张东升,等. 三种经脐入路内镜手术置入装置的实验研究[J/CD]. 中华腔镜外科杂志(电子版),2012,5(6):7-10.
14
龚瑶,周容,代雪林,等. 自制入路通道单孔腹腔镜手术治疗妇科良性疾病60例临床分析[J]. 中国实用妇科与产科杂志,2019,35(3):1026-1029.
15
龚瑶,唐均英. 单孔腹腔镜下直器械间的"小三角"操作模式的临床体会[J]. 腹腔镜外科杂志,2019,24(8):634-636.
[1] 徐敬云, 丁波, 蒋宇慧, 沈杨. 妊娠期单孔腹腔镜手术实施行与思[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 262-266.
[2] 王酉, 严斌, 狄文, 楼微华. 经脐单孔腹腔镜前哨淋巴结活检术在早期子宫内膜癌手术中的探讨[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(03): 173-176.
[3] 张可欣, 孙大为, 任常. 国产单孔蛇形臂腹腔镜机器人在妇科领域的应用探索[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(02): 106-110.
[4] 张海滨, 魏春娜, 侯旭宁, 于彩虹, 姚景润, 张真. 妇科良性疾病经脐单孔腹腔镜手术后疼痛程度与美观效果研究[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 51-54.
[5] 封意兰, 赵仁峰. 经脐单孔腹腔镜剔除特殊部位子宫肌瘤[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 26-29.
[6] 孙大为, 张俊吉, 任常. 中国大陆妇科单孔腹腔镜手术技术的进步及展望[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 1-3.
[7] 缪妙, 王一娜, 陈继明, 汤慧敏, 陈尧, 单武林, 贾秋成, 魏炜炜, 唐斌, 郑虹. 经腹壁瘢痕入路单孔腹腔镜子宫肌瘤剥除术临床分析[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(06): 348-352.
[8] 杨晓英, 张葛, 徐晓萌, 孙雅欣, 苗月圆, 马迎春. 三种不同腹腔镜入路行大子宫切除术临床疗效评估[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(06): 331-337.
[9] 中国医师协会妇产科医师分会妇科单孔腹腔镜全国科研协作组. 妇科单孔腹腔镜手术镜下联合体外操作模式临床应用专家共识[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(04): 200-209.
[10] 曾纪晓, 徐晓钢, 刘斐, 兰梦龙, 陶波圆, 梁子建, 王欣星. 单孔腹腔镜在先天性长段型巨结肠分期手术的运用[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(02): 96-100.
[11] 缪妙, 邢庭玮, 陈继明, 陈尧, 夏百荣, 单武林, 唐斌, 杜雨, 郑虹, 施如霞. 单孔腹腔镜镜下联合体外操作模式在妇科疾病诊治中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(02): 120-123.
[12] 王慧慧, 陈继明, 夏百荣, 张文笛, 秦真岳, 鲍明月, 余红霞, 张守枫, 魏炜炜, 施如霞. 经阴道单孔腹腔镜手术在妇科中的应用进展[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(02): 123-128.
[13] 张葛, 金振伟, 李颖, 刘腾, 杨晓英, 徐晓萌, 马迎春. 经脐单孔腹腔镜加辅助孔行卵巢巨大恶性肿瘤全面分期手术一例[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(01): 58-61.
[14] 金贝贝, 张玉泉, 李季, 高赛楠, 朱春玉, 丁晓颖, 杨晓清. 普通及机器人辅助经脐单孔腹腔镜在子宫肌瘤剔除术中的应用比较[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(03): 163-167.
[15] 秦真岳, 王慧慧, 陈继明, 鲍明月, 郑亚峰, 肖惠超, 马洋, 蒋云芬, 施如霞. 单孔腹腔镜手术治疗Ⅲ型(包块型)子宫瘢痕妊娠[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(02): 122-126.
阅读次数
全文


摘要