シミュレーターを用いた腹腔鏡下胆囊摘出術の技術評価

Evaluation of surgical skills using a simulator in laparoscopic cholecystectomy

◆要旨：【目的】シミュレーターを用いて，腹腔鏡下手術の初心者に対する評価基準構築の可能性を探った．【方法】後期研修医5名を対象に手術手技とシミュレーター手技を比較した．手術評価は技術認定の審査基準を用いた．シミュレーターは協調運動が必要な項目を選択し（タスク6，9），時間，手数，鉗子の移動距離，有効性などを点数化した．【結果】タスク9では手術手技との乖離を認めたが，タスク6では手術手技と相関がみられた．タスク6で，総得点と関連を持つ特定のパラメーターは見いだせなかった．【結論】初心者における手術手技評価をシミュレーターで代用できる可能性が示唆された．実際の評価には絶対的な基準の決定が必要である．

［Purpose］The aim of this study is to search for the possibility of using simulator to evaluate the technical skills of laparoscopic cholecystectomy in beginners. ［Methods］Technical skills by 5 senior residents were evaluated and compared in both simulator and laparoscopic cholecystectomy. A technical authorization system of Japan Society for Endoscopic Surgery was used to evaluate the operative skills. For simulator, some tasks that require coordination were selected （Task6,9）, and parameters such as total time, number of movement, total path length and movement efficiency of forceps were scored. ［Results］Technical skills under simulator had no correlation to operative skills in task 9 though the relation was seen in task 6. Specific parameter which reflects to the total score was not found in task 6. ［Conclusion］The possibility to evaluate operative technical skills in simulator was shown. Absolute standard for actual evaluation would be necessary.