Analysis and discussion of the research status of thoracoscopic and laparoscopicsimulation training and assessment_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Jian , LIAO Hu , ZHENG Quan ,  LIU Lunxu

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Simulation training; assessment; thoracoscopic and laparoscopic; Huaxi Intelligent Thoracoscopic Skill Training and Assessment System

DOI：

10.7507/1007-4848.202311033

Video：

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Minimally invasive surgery is the development direction of surgery in the 21st century, and thoracoscopic or laparoscopic skills are essential skills that all surgeons must master. Thoracoscopic or laparoscopic skills training is an important part of surgical resident training. However, there are various methods for thoracoscopic or laparoscopic skill training internationally. The assessment is still in the stage of examiners’ visual observation and subjective evaluation. Here, we reviewed the current research status of thoracoscopic and laparoscopic simulation training and assessment, discussed the development experience and application achievements of Huaxi Intelligent Thoracoscopic Skill Training and Assessment System. We aimed to provide a theoretical basis and practical experience for the development of thoracoscopic or laparoscopic simulation education.

Citation： ZHOU Jian, LIAO Hu, ZHENG Quan, LIU Lunxu. Analysis and discussion of the research status of thoracoscopic and laparoscopicsimulation training and assessment. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 667-671. doi: 10.7507/1007-4848.202311033 Copy

1.	St John A, Caturegli I, Kubicki NS, et al. The rise of minimally invasive surgery: 16 year analysis of the progressive replacement of open surgery with laparoscopy. JSLS, 2020, 24(4): e 2020.00076.
2.	郑民华, 马君俊, 吴超. 微创外科近20年进展及未来发展趋势. 中国实用外科杂志, 2020, 40(1): 23-26, 32.
3.	廖虎, 梅建东, 刘成武, 等. 中国三级医院胸外科学科临床发展现状的调查研究. 中华外科杂志, 2018, 56(12): 888-891.
4.	Cendan J, Wier D, Behrns K. A primer on standards setting as it applies to surgical education and credentialing. Sur Endoscopy, 2013, 27(7): 2631-2637.
5.	Bendixen M, Jorgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
6.	Tang W, Zhang YF, Zhao YF, et al. Comparison of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: A systematic review and meta-analysis. Int J Surg, 2022, 103: 106676.
7.	Wong KC, Lee KF, Lo EYJ, et al. Minimally invasive versus open liver resection for hepatocellular carcinoma: A propensity score matching analysis of 224 patients. Langenbecks Arch Surg, 2023, 408(1): 118.
8.	Munro M G. Surgical simulation: Where have we come from? Where are we now? Where are we going? J Minim Invasive Gynecol, 2012, 19(3): 272-283.
9.	Sullivan ME. Applying the science of learning to the teaching and learning of surgical skills: The basics of surgical education. J Surg Oncol, 2020, 122(1): 5-10.
10.	夏扬, 李卫民. 利用模拟医院培养腔镜医生临床技能的探索与实践. 中国职业技术教育, 2013, 11: 84-86.
11.	Tarras SL, Thacker J, Bouwman DL, et al. Effective large group teaching for general surgery. Surg Clin North Am, 2021, 101(4): 565-576.
12.	Ferguson MK, Bennett C. Identification of essential components of thoracoscopic lobectomy and targets for simulation. Ann Thorac Surg, 2017, 103(4): 1322-1329.
13.	李永宁, 喻超, 李英, 等. 单中心腹腔镜肝部分切除术学习曲线分析. 中华普外科手术学杂志(电子版), 2021, 15(4): 376-379.
14.	吴昊钧, 汪大刚, 梁梦萍, 等. 结合术前三维重建的腹腔镜肝切除术学习曲线研究. 肝胆胰外科杂志, 2022, 34(9): 537-542.
15.	Cypel M, Yasufuku K. Complications during minimal invasive thoracic surgery: Are new surgeons prepared? Lancet Oncol, 2018, 19(1): 17-19.
16.	Nashaat A, Sidhu HS, Yatham S, et al. Simulation training for lobectomy: A review of current literature and future directions. Eur J Cardiothorac Surg, 2019, 55(3): 386-394.
17.	Orejuela FJ, Aschkenazi SO, Howard DL, et al. Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: A systematic review and meta-analysis. Am J Obstet Gynecol, 2022, 227(1): 29.e1-29.e4.
18.	Goldenberg MG, Garbens A, Szasz P, et al. Systematic review to establish absolute standards for technical performance in surgery. Br J Surg, 2017, 104(1): 13-21.
19.	张克勤, 李蜀婧, 毕罡. 内镜与微创培训在泌尿外科临床教学中的应用. 局解手术学杂志, 2014, 23(3): 318-319.
20.	谢艳丽, 张冬雅, 韩丽萍. 宫腔镜仿真模拟系统在妇科临床培训中的应用. 中国继续医学教育, 2022, 14(24): 113-117.
21.	王凤蛟, 李雪鑫, 张磊, 等. 基于Lap Mentor的HACCP技术在住培医生腔镜培训质控中的应用研究. 解放军预防医学杂志, 2020, 38(2): 75-77, 80.
22.	王春茂, 王隽, 韩鸣, 等. 虚拟仿真腔镜模拟训练器在胸外科住院医师培训中的应用探讨. 中国医刊, 2023, 58(8): 923-926.
23.	邓建华, 吴海坤, 李薇, 等. 北京协和医院基于SMART原则的泌尿外科专科腔镜规范化培训的经验总结. 中国医学科学院学报, 2023, 45(1): 88-91.
24.	胡孔旺, 陆明, 王宜文, 等. 三层次培训在规培生腔镜技能培训中的应用研究. 中国高等医学教育, 2017, 11: 9-10.
25.	李晓军, 张佳, 张靖, 等. 胸外科住院医师规范化培训中胸腔镜手术的培养与训练. 临床医学研究与实践, 2018, 3(8): 195-196.
26.	Vassiliou MC, Dunkin BJ, Marks JM, et al. FLS and FES: comprehensive models of training and assessment. Surg Clin North Am, 2010, 90(3): 535-558.
27.	Castellvi AO, Hollett LA, Minhajuddin A, et al. Maintaining proficiency after fundamentals of laparoscopic surgery training: A 1-year analysis of skill retention for surgery residents. Surg, 2009, 146(2): 387-93.
28.	Rooney DM, Santos BF, Hungness ES. Fundamentals of laparoscopic surgery (FLS) manual skills assessment: Surgeon vs nonsurgeon raters. J Surg Educ, 2012, 69(5): 588-592.
29.	Higgins RM, Turbati MS, Goldblatt MI. Preparing for and passing the fundamentals of laparoscopic surgery (FLS) exam improves general surgery resident operative performance and autonomy. Surg Endosc, 2023, 37(8): 6438-6444.
30.	Sansregret A, Fried GM, Hasson H, et al. Choosing the right physical laparoscopic simulator? Comparison of LTS2000-ISM60 with MISTELS: Validation, correlation, and user satisfaction. Am J Surg, 2009, 197(2): 258-65.
31.	Lazar A, Sroka G, Laufer S. Automatic assessment of performance in the FLS trainer using computer vision. Surg Endosc, 2023, 37(8): 6476-6482.
32.	Clark NV, Pepin KJ, Einarsson JI. Surgical skills assessment tools in gynecology. Curr Opin Obstet Gynecol, 2018, 30(5): 331-336.
33.	Campo R, Wattiez A, Tanos V, et al. Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery. Eur J Obstet Gynecol Reprod Biol, 2016, 199: 183-186.
34.	李善姬, 顾卓伟, 施君, 等. 妇科内镜手术培训与考核体系在住培中期测评的价值研究. 中国继续医学教育, 2022, 14(6): 77-82.
35.	卢冠军, 侯春丽, 侯学红, 等. 腹腔镜模拟训练器在腹腔镜培训中的应用. 宁夏医科大学学报, 2013, 10: 1153-1155,1194.
36.	张爱民, 戴一扬, Beller S, 等. 腹腔镜模拟训练在腔镜外科中的应用. 中国微创外科杂志, 2008, 1: 7-10.
37.	王李, 徐琰, 黄彬, 等. 腹腔镜外科基础规范化教学在住培医师教学中的应用. 中国继续医学教育, 2022, 14(16): 137-140.
38.	邱建国, 唐伟, 李明. 腹腔镜模拟训练系统在肝胆外科住院医师规范化培训中的应用研究. 现代医药卫生, 2020, 36(22): 3673-3675.
39.	Vassiliou MC, Feldman LS, Andrew CG, et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg, 2005, 190(1): 107-113.
40.	Gumbs AA, Hogle NJ, Fowler DL. Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills. J Am Coll Surg, 2007, 204(2): 308-313.
41.	Seagull FJ, Rooney DM. Filling a void: Developing a standard subjective assessment tool for surgical simulation through focused review of current practices. Surg, 2014, 156(3): 718-722.
42.	Ketel MHM, Klarenbeek BR, Eddahchouri Y, et al. Crowd-sourced and expert video assessment in minimally invasive esophagectomy. Surg Endosc, 2023, 37(10): 7819-7828.
43.	VAssiliou MC, Kaneva PA, Poulose BK, et al. Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): A valid measurement tool for technical skills in flexible endoscopy. Surg Endosc, 2010, 24(8): 1834-41.
44.	廖虎, 蒲丹, 陈楠, 等. 华西智能化腔镜技能训练及考核系统的构建. 四川大学学报(医学版), 2018, 49(5): 776-780.
45.	Zhou J, Liao H, Lin Z, et al. A new basic thoracoscopic surgical skill training and assessment system using automatic scoring techniques. Surg Endosc, 2022, 36(5): 3076-3086.
46.	Crochet P, Agostini A, Knight S, et al. The performance gap for residents in transfer of intracorporeal suturing skills from box trainer to operating room. J Surg Educ, 2017, 74(6): 1019-1027.

1. St John A, Caturegli I, Kubicki NS, et al. The rise of minimally invasive surgery: 16 year analysis of the progressive replacement of open surgery with laparoscopy. JSLS, 2020, 24(4): e 2020.00076.
2. 郑民华, 马君俊, 吴超. 微创外科近20年进展及未来发展趋势. 中国实用外科杂志, 2020, 40(1): 23-26, 32.
3. 廖虎, 梅建东, 刘成武, 等. 中国三级医院胸外科学科临床发展现状的调查研究. 中华外科杂志, 2018, 56(12): 888-891.
4. Cendan J, Wier D, Behrns K. A primer on standards setting as it applies to surgical education and credentialing. Sur Endoscopy, 2013, 27(7): 2631-2637.
5. Bendixen M, Jorgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
6. Tang W, Zhang YF, Zhao YF, et al. Comparison of laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: A systematic review and meta-analysis. Int J Surg, 2022, 103: 106676.
7. Wong KC, Lee KF, Lo EYJ, et al. Minimally invasive versus open liver resection for hepatocellular carcinoma: A propensity score matching analysis of 224 patients. Langenbecks Arch Surg, 2023, 408(1): 118.
8. Munro M G. Surgical simulation: Where have we come from? Where are we now? Where are we going? J Minim Invasive Gynecol, 2012, 19(3): 272-283.
9. Sullivan ME. Applying the science of learning to the teaching and learning of surgical skills: The basics of surgical education. J Surg Oncol, 2020, 122(1): 5-10.
10. 夏扬, 李卫民. 利用模拟医院培养腔镜医生临床技能的探索与实践. 中国职业技术教育, 2013, 11: 84-86.
11. Tarras SL, Thacker J, Bouwman DL, et al. Effective large group teaching for general surgery. Surg Clin North Am, 2021, 101(4): 565-576.
12. Ferguson MK, Bennett C. Identification of essential components of thoracoscopic lobectomy and targets for simulation. Ann Thorac Surg, 2017, 103(4): 1322-1329.
13. 李永宁, 喻超, 李英, 等. 单中心腹腔镜肝部分切除术学习曲线分析. 中华普外科手术学杂志(电子版), 2021, 15(4): 376-379.
14. 吴昊钧, 汪大刚, 梁梦萍, 等. 结合术前三维重建的腹腔镜肝切除术学习曲线研究. 肝胆胰外科杂志, 2022, 34(9): 537-542.
15. Cypel M, Yasufuku K. Complications during minimal invasive thoracic surgery: Are new surgeons prepared? Lancet Oncol, 2018, 19(1): 17-19.
16. Nashaat A, Sidhu HS, Yatham S, et al. Simulation training for lobectomy: A review of current literature and future directions. Eur J Cardiothorac Surg, 2019, 55(3): 386-394.
17. Orejuela FJ, Aschkenazi SO, Howard DL, et al. Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: A systematic review and meta-analysis. Am J Obstet Gynecol, 2022, 227(1): 29.e1-29.e4.
18. Goldenberg MG, Garbens A, Szasz P, et al. Systematic review to establish absolute standards for technical performance in surgery. Br J Surg, 2017, 104(1): 13-21.
19. 张克勤, 李蜀婧, 毕罡. 内镜与微创培训在泌尿外科临床教学中的应用. 局解手术学杂志, 2014, 23(3): 318-319.
20. 谢艳丽, 张冬雅, 韩丽萍. 宫腔镜仿真模拟系统在妇科临床培训中的应用. 中国继续医学教育, 2022, 14(24): 113-117.
21. 王凤蛟, 李雪鑫, 张磊, 等. 基于Lap Mentor的HACCP技术在住培医生腔镜培训质控中的应用研究. 解放军预防医学杂志, 2020, 38(2): 75-77, 80.
22. 王春茂, 王隽, 韩鸣, 等. 虚拟仿真腔镜模拟训练器在胸外科住院医师培训中的应用探讨. 中国医刊, 2023, 58(8): 923-926.
23. 邓建华, 吴海坤, 李薇, 等. 北京协和医院基于SMART原则的泌尿外科专科腔镜规范化培训的经验总结. 中国医学科学院学报, 2023, 45(1): 88-91.
24. 胡孔旺, 陆明, 王宜文, 等. 三层次培训在规培生腔镜技能培训中的应用研究. 中国高等医学教育, 2017, 11: 9-10.
25. 李晓军, 张佳, 张靖, 等. 胸外科住院医师规范化培训中胸腔镜手术的培养与训练. 临床医学研究与实践, 2018, 3(8): 195-196.
26. Vassiliou MC, Dunkin BJ, Marks JM, et al. FLS and FES: comprehensive models of training and assessment. Surg Clin North Am, 2010, 90(3): 535-558.
27. Castellvi AO, Hollett LA, Minhajuddin A, et al. Maintaining proficiency after fundamentals of laparoscopic surgery training: A 1-year analysis of skill retention for surgery residents. Surg, 2009, 146(2): 387-93.
28. Rooney DM, Santos BF, Hungness ES. Fundamentals of laparoscopic surgery (FLS) manual skills assessment: Surgeon vs nonsurgeon raters. J Surg Educ, 2012, 69(5): 588-592.
29. Higgins RM, Turbati MS, Goldblatt MI. Preparing for and passing the fundamentals of laparoscopic surgery (FLS) exam improves general surgery resident operative performance and autonomy. Surg Endosc, 2023, 37(8): 6438-6444.
30. Sansregret A, Fried GM, Hasson H, et al. Choosing the right physical laparoscopic simulator? Comparison of LTS2000-ISM60 with MISTELS: Validation, correlation, and user satisfaction. Am J Surg, 2009, 197(2): 258-65.
31. Lazar A, Sroka G, Laufer S. Automatic assessment of performance in the FLS trainer using computer vision. Surg Endosc, 2023, 37(8): 6476-6482.
32. Clark NV, Pepin KJ, Einarsson JI. Surgical skills assessment tools in gynecology. Curr Opin Obstet Gynecol, 2018, 30(5): 331-336.
33. Campo R, Wattiez A, Tanos V, et al. Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery. Eur J Obstet Gynecol Reprod Biol, 2016, 199: 183-186.
34. 李善姬, 顾卓伟, 施君, 等. 妇科内镜手术培训与考核体系在住培中期测评的价值研究. 中国继续医学教育, 2022, 14(6): 77-82.
35. 卢冠军, 侯春丽, 侯学红, 等. 腹腔镜模拟训练器在腹腔镜培训中的应用. 宁夏医科大学学报, 2013, 10: 1153-1155,1194.
36. 张爱民, 戴一扬, Beller S, 等. 腹腔镜模拟训练在腔镜外科中的应用. 中国微创外科杂志, 2008, 1: 7-10.
37. 王李, 徐琰, 黄彬, 等. 腹腔镜外科基础规范化教学在住培医师教学中的应用. 中国继续医学教育, 2022, 14(16): 137-140.
38. 邱建国, 唐伟, 李明. 腹腔镜模拟训练系统在肝胆外科住院医师规范化培训中的应用研究. 现代医药卫生, 2020, 36(22): 3673-3675.
39. Vassiliou MC, Feldman LS, Andrew CG, et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg, 2005, 190(1): 107-113.
40. Gumbs AA, Hogle NJ, Fowler DL. Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills. J Am Coll Surg, 2007, 204(2): 308-313.
41. Seagull FJ, Rooney DM. Filling a void: Developing a standard subjective assessment tool for surgical simulation through focused review of current practices. Surg, 2014, 156(3): 718-722.
42. Ketel MHM, Klarenbeek BR, Eddahchouri Y, et al. Crowd-sourced and expert video assessment in minimally invasive esophagectomy. Surg Endosc, 2023, 37(10): 7819-7828.
43. VAssiliou MC, Kaneva PA, Poulose BK, et al. Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): A valid measurement tool for technical skills in flexible endoscopy. Surg Endosc, 2010, 24(8): 1834-41.
44. 廖虎, 蒲丹, 陈楠, 等. 华西智能化腔镜技能训练及考核系统的构建. 四川大学学报(医学版), 2018, 49(5): 776-780.
45. Zhou J, Liao H, Lin Z, et al. A new basic thoracoscopic surgical skill training and assessment system using automatic scoring techniques. Surg Endosc, 2022, 36(5): 3076-3086.
46. Crochet P, Agostini A, Knight S, et al. The performance gap for residents in transfer of intracorporeal suturing skills from box trainer to operating room. J Surg Educ, 2017, 74(6): 1019-1027.

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Analysis and discussion of the research status of thoracoscopic and laparoscopicsimulation training and assessment

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