学习柔性内窥镜,特别是内窥镜真空治疗。

4区 医学 Q3 Medicine Chirurg Pub Date : 2022-01-01 Epub Date: 2021-09-27 DOI:10.1007/s00104-021-01497-4
K E Grund, U Schweizer, A Zipfel, B Duckworth-Mothes
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引用次数: 1

摘要

背景:胃肠道吻合口不全和穿孔是严重的并发症,并发症发生率高,死亡率高。常规治疗方案(尤其是再手术)往往不能令人满意。内窥镜真空治疗(EVT)作为一种有前景的替代方法正越来越多地被使用。问题:EVT的使用需要高水平的介入柔性内窥镜检查能力,这主要不是每个外科医生都能做到的。这里需要特殊的培训项目。方法:基于这一需求,对久经考验的柔性内窥镜Tuebingen培训系统进行了改进,以满足外科医生的特殊要求,目前正在扩展EVT的特殊培训模块。结果:在理论原理的基础上,重点学习了柔性内窥镜的操作技巧。为此,我们制定了一个两阶段的过程:1)通过教学优化的抽象幻影(“Tuebingen Orientophant”)熟悉柔性内窥镜的操作并学习空间定向;2)使用新开发的具有各种缺陷和上下胃肠道脓肿腔的患者模拟训练模型(“Tuebingen Spongiophant”)学习和训练EVT。这个过程可以像病人一样一步一步地训练,海绵可以用不同的方法应用,比如管上和拖拽程序。错误的后果和复杂的管理也可以理想地训练动手使用幻影。讨论:对第一个课程系列的评估表明,外科医生很快就能掌握内窥镜操作能力,并学会掌握新的操作方法。然而,这种课程的结构必须根据长期的经验以最佳的教学方式来设计。医疗保健政策的决策者应该给予这些课程更多的支持,以改善患者护理和提高患者安全。
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Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT).

Background: Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative.

Problem: The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here.

Methods: Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT.

Results: In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom.

Discussion: Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.

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来源期刊
Chirurg
Chirurg 医学-外科
CiteScore
1.10
自引率
0.00%
发文量
91
审稿时长
4-8 weeks
期刊介绍: Der Chirurg; Zeitschrift fur Alle Gebiete der Operativen Medizen The magazine is intended for surgeons in hospitals, clinics and research. Each issue includes a comprehensive theme: Practical summaries access to selected topics and provide the reader with a compilation of current knowledge in all fields of surgery. Besides imparting relevant background knowledge, the emphasis is on the review of scientific results and practical experience. The reader will find concrete recommendations.
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