基于虚拟现实技术的机器人辅助腹腔镜肾盂成形术分段式培训体系的建立和应用  

Establishment and application of a segmented training system for robot-assisted laparoscopic pyeloplasty based on virtual reality technology

作　　者：叶宸[1] 杨懿人 徐梦璐 施晓磊[1] 薛庆 庞庆阳 柳文强 肖成武[1] 张威[1,3] YE Chen;YANG Yi-ren;XU Meng-lu;SHI Xiao-lei;XUE Qing;PANG Qing-yang;LIU Wen-qiang;XIAO Cheng-wu;ZHANG Wei(Department of Urology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Intuitive Surgical-Fosun Medical Technology(Shanghai)Co.,Ltd.,Shanghai 201200,China;Department of Surgery and Field Surgery,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院泌尿外科,上海200433 [2]直观复星医疗器械技术(上海)有限公司,上海201200 [3]海军军医大学(第二军医大学)第一附属医院外科学与野战外科学教研室,上海200433

出　　处：《海军军医大学学报》2023年第4期493-498,共6页Academic Journal of Naval Medical University

基　　金：海军军医大学(第二军医大学)启航人才培养计划(2021)。

摘　　要：目的建立一种基于虚拟现实技术的分段式培训体系,并应用于机器人辅助腹腔镜肾盂成形术(RALP的手术培训。方法采用虚拟现实技术,通过机器人模拟培训系统对3名泌尿外科医师进行基础操作培训和缝合相关技能培训,对比培训前后受训医师术中吻合时间等关键指标的变化。将RALP分为游离、裁剪、吻合、缝合4个分段,受训医师通过机器人系统参与真实手术操作,先以分段为单位完成学习曲线,再独立完成完整的RALP。结果经虚拟现实培训后,受训医师术中的吻合时间[(141.0±9.0)s vs(312.6±34.5)s]和运动距离[(140.9±16.2)cm vs(323.1±50.6)cm]显著缩短(P均<0.01),机械臂碰撞次数[(1.6±0.6)次vs(7.1±1.0)次]和器械离开视野次数[(0.8±0.5)次vs(3.2±0.9)次]显著减少(P均<0.05),脱离目标次数在训练前后差异无统计学意义(P>0.05)。经每人2轮的分段式真实手术训练后,受训医师独立完成RALP,其手术时间较具备成熟RALP手术经验医师同期的手术时间略长[(149.0±36.0)min vs(117.0±10.0)min],但差异无统计学意义(P=0.060);术中出血量、漏尿发生率和术后住院时间等围手术期指标差异也均无统计学意义(P均>0.05)。结论基于虚拟现实技术的分段式培训体系可成功应用于RALP的手术培训,其可在保证手术安全性和质量的前提下提高受训医师的操作水平,使其具备独立完成RALP的能力。Objective To establish a virtual reality technology-based segmented training system and apply it to the surgical training of robot-assisted laparoscopic pyeloplasty(RALP).Methods Virtual reality technology was used to conduct basic operation training and intensive training of suture-related skills for 3 urologists through a robotic simulation training system,and the changes in key indicators such as anastomosis time of the trained urologists were compared before and after the training.The RALP was divided into 4 segments:separating,cutting,anastomosis,and suturing.The trained surgeons participated in real surgical operations through the robotic system,first completing the learning curve in segments and then completing the whole RALP independently.Results After virtual reality training,the anastomotic time([141.0±9.0]s vs[312.6±34.5]s)and motion distance[(140.9±16.2]cm vs[323.1±50.6]cm)were significantly shortened(both P<0.01),and the times of both instrument collisions(1.6±0.6 vs 7.1±1.0)and instrument out of sight(0.8±0.5 vs 3.2±0.9)were significantly reduced(both P<0.05).However,the times of missed target did not change significantly before and after training(P>0.05).After 2 rounds of segmented training per person,trainees were able to conduct RALP independently.Their operation time was longer than that of senior surgeons([149.0±36.0]min vs[117.0±10.0]min),but the difference was not statistically significant(P>0.05).In addition,there were no significant differences in perioperative indicators such as intraoperative blood loss,incidence of urine leakage,or postoperative hospital stay(all P>0.05).Conclusion The virtual reality technology-based segmented training system can be successfully applied to the surgical training of RALP,and it can improve the operational skills of trainees on the premise of ensuring the safety and quality of the operation.

关 键 词：机器人手术 腹腔镜肾盂成形术 虚拟现实 分段式培训体系 

分 类 号：R699.2[医药卫生—泌尿科学]