Zusammenfassung
Hintergrund
Die minimal-invasive Chirurgie (MIC) fordert vom Chirurgen im Vergleich zur offenen Chirurgie zusätzliches Geschick und Fähigkeiten. Die indirekte Kamerasicht, fehlende dreidimensionale Sicht, mangelndes Gewebegefühl sowie die schwierige Instrumentenkoordination mit Drehpunkt- und Hebeleffekt führen zu einer verlängerten Lernkurve. Das resultierende höhere Risiko zur Entstehung von Komplikationen bedingt ein spezielles Risikobewusstsein. Ein Training der speziellen Fähigkeiten für die Laparoskopie außerhalb des Operationssaales scheint notwendig, um die Sicherheit der Patienten zu optimieren und die mit der Lernkurve einhergehenden Komplikationsrisiken zu minimieren.
Ergebnisse und Diskussion
Die Trainingsmodalitäten für die laparoskopische Chirurgie beinhalten Box-Trainer, Computersimulatoren mit virtueller Realität, künstliche und Kadaverorgane sowie Lebendtiermodelle und Kadavermodelle. Diese Trainingsmodalitäten haben einen in Studien bewiesenen Einfluss auf die Lernkurve der laparoskopischen Fähigkeiten sowie auf die Qualität der Durchführung von Operationen und die Vermeidung von Komplikationen. Das Laparoskopietraining spielt eine immer wichtigere Rolle in der Akkreditierung und fachlichen Anerkennung. In einigen Ländern wurden laparoskopische Trainingskurse vor dem ersten Einsatz im Operationssaal am Patienten bereits verpflichtend eingeführt. Zukünftige Studien werden die optimale Zusammensetzung multimodaler Trainingskurrikula untersuchen und individualisierte Trainee- und patientenspezifische Trainingsansätze entwickeln. Neue technische Entwicklungen werden die Kollektion und Weitergabe von Erfahrung und Können zwischen den Generationen und Schulen der Chirurgie vereinfachen, um letztlich die Behandlung der Patienten in der Chirurgie so sicher und schonend wie möglich zu gestalten.
Abstract
Background
Minimally invasive surgery (MIC) requires surgeons to have a different set of skills and capabilities from that of open surgery. The indirect camera view, lack of a three-dimensional view, restricted haptic feedback with lack of tissue feeling and difficult instrument coordination with fulcrum and pivoting effects result in an additional learning curve compared to open surgery. The prolonged learning curve leads to a higher risk of complications and special awareness of these risks is therefore mandatory. Training of special laparoscopic skills outside the operating room is needed to optimize patient outcome and to minimize the ocurrence of complications related to the learning curve.
Results and discussion
Training modalities for laparoscopic surgery include simple box trainers, computer simulation with virtual reality, the use of artificial and cadaver organs, as well as live animal models and cadaver training. These training modalities have been proven in studies to have a beneficial effect on the learning curve for acquisition of laparoscopic skills and for improving operative performance as well as avoidance of complications. Laparoscopic training is currently gaining a more and more important role for official education and accreditation purposes. In some countries the participation in laparoscopic training courses has become mandatory prior to participation in laparoscopic operations. Future research will include the optimization of multimodal training curricula, the development of individualized training approaches that allow both trainee and patient-specific preparation, as well as the use of novel devices to facilitate the collection and transfer of expertise between the generations and schools of surgeons.
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F. Nickel, K.-F. Kowalewski und B.P. Müller-Stich geben an, dass kein Interessenkonflikt besteht.
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Nickel, F., Kowalewski, KF. & Müller-Stich, B. Risikobewusstsein und Training zur Prävention von Komplikationen in der minimal-invasiven Chirurgie. Chirurg 86, 1121–1127 (2015). https://doi.org/10.1007/s00104-015-0097-6
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DOI: https://doi.org/10.1007/s00104-015-0097-6