腹腔鏡下縫合結紮の勘所～ドライボックス・トレーニングにおける縫合結紮の要素を言語化して分かったこと～

抄録

  Verbalized feedback on intracorporeal suturing and knot-tying movements was incorporated into our institute's assessments, and important aspects of the procedures were identified for future introduction in the training module.

  Seven valuers and six participants receiving training in laparoscopic surgery, blinded to each other, were recruited by a moderator who ensured fair assessments. Five courses of tasks and assessments were performed every 2 weeks for 3 months (April–June 2020). Tasks such as holding and handling the needle, and surgical and slip knot tying were performed with dry box training on a vaginal stump model. The moderator uploaded performance videos online, viewable by only participants and valuers, which the valuers assessed using a Google form, the Global Rating Scale, and verbalized free comments, including what could and could not be done and three focus areas, as feedback.

  We classified verbalized free comments into those on holding and handling the needle; pulling and cutting the thread; and general, surgical, and slip knot tying, among others. Most comments addressed surgical or slip knot tying. Valuers provided varying opinions on techniques, but all emphasized understanding the principle by training under direct vision, actively using the non-dominant hand, inter-hand coordination, holding the thread or tissue by the forceps tip, proper length adjustment of the short or long tail, and direction of pulling the thread.

  With verbalized assessments, we identified focus areas and issues initially observed in the suturing and knot-tying training; this is a potential index for training and should be introduced as such.