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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20～22kg)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300min缩短到第20例的150min,平均手术时间185min,平均出血量为160mL。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。
Objective To evaluate the effect and clinical significance of stepwise training mode in radical prostatectomy of robot. Methods The staged training mode of robotic radical prostatectomy was used to improve the operating skills and coordination of the surgical team. The training mode is divided into four stages: the first stage for the model training, stripping the grape skin, threading, picking beans, paper-cut so that participants are fully familiar robot equipment and applications; the second phase of live animal experiments, participants Using a non-castrated male dog (age 5 years old, body weight 20 ~ 22kg) underwent laparoscopic robotic prostatectomy, fully experienced and familiar with the surgical procedure of robotic laparoscopic prostatectomy and the application of key technologies, and run the surgical team; In the third phase, participants from the first phase and the second phase were divided into two groups. Each of the assistant and instructor nurses viewed the video of the classic surgery to discuss the surgical procedures, anatomical points and skills, and standardized the surgical procedures. Stage 4 is clinical practice, choose the appropriate case of robotic laparoscopic radical prostatectomy, and the evening of the operation, the team members gathered to analyze the video analysis, summarize, put forward suggestions for improvement. Results By step training, we performed 20 cases of robotic laparoscopic radical prostatectomy in 10 months. The operation time was shortened from 300 cases in the first case to 150 cases in the 20 cases. The average operation time was 185 minutes and the average bleeding volume was 160ml. Surgery were carried out smoothly, without any transfer to open, no intraoperative complications. The total training time in 4 stages is about 10 months. Conclusions The whole team training through the step training model of radical prostatectomy can greatly shorten the learning curve, improve the success rate of surgery and reduce the incidence of surgical complications.