Name: emergency undocking in robotic surgery: a simulation curriculum
Uploaded: 2018-05-20T14:00:00
Description: Watch this Scientific Journal Video about Emergency Undocking in Robotic Surgery: A Simulation Curriculum at JoVE.com

作者希望感谢医学模拟技术员杰瑞德设计的改良躯干, 和总结健康, 阿克伦校区手术室人员。这个项目没有外部资金。

irb 确定, 根据联邦定义的 45 CFR 46.101 类的豁免审查类别, 该项目免受 IRB 审查。
1. 收集和准备材料
<ol><li>为培训课程收集材料, 包括配备2训练臂的机器人系统 (参见材料表)、3套管针和腹腔镜。</li>
	<li>在空心训练躯干, 创造至少3个单独切口与手术刀放置腹腔镜仪器套管针。确保切口与机器人手术中发现的相同,即,在脐上方, 每一个右侧和左下象限大到足以?...

<ol>
	<li>Huser, A. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulated+life-threatening+emergency+during+robot-assisted+surgery.">Simulated life-threatening emergency during robot-assisted surgery.</a> J Endourol. 28 (6), 717-721 (2014).</li><li>Berry, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+resuscitation+in+the+operating+room:+reflections+on+how+we+can+do+better.">Cardiac resuscitation in the operating room: reflections on how we can do better.</a> Can J Anaesth. 59 (6), 522-526 (2012).</li><li>Shaligram, A., Meyer, A., Simorov, A., Pallati, P., Oleynikov, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survey+of+minimally+invasive+general+surgery+fellows+training+in+robotic+surgery.">Survey of minimally invasive general surgery fellows training in robotic surgery.</a> J Robot Surg. 7 (2), 131-136 (2013).</li><li>Acero, N. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Managing+a+surgical+exsanguination+emergency+in+the+operating+room+through+simulation:+an+interdisciplinary+approach.">Managing a surgical exsanguination emergency in the operating room through simulation: an interdisciplinary approach.</a> J Surg Educ. 69 (6), 759-765 (2012).</li><li>Hoffman, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+of+robotic+radical+hysterectomy+using+the+porcine+model.">Simulation of robotic radical hysterectomy using the porcine model.</a> J Robot Surg. 6 (3), 237-239 (2012).</li><li>Goonewardene, S. S., Cahill, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+surgery,+skills+and+simulation:+a+technical+sport.">Robotic surgery, skills and simulation: a technical sport.</a> J Robot Surg. 10 (1), 85-86 (2016).</li><li>Meier, M., Horton, K., John, H. D. a. V. i. n. c. i. &. #. 1. 6. 9. ;. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Skills+Simulator&#8482;:+is+an+early+selection+of+talented+console+surgeons+possible.">Skills Simulator&#8482;: is an early selection of talented console surgeons possible.</a> J Robot Surg. 10 (4), 289-296 (2016).</li><li>Gaba, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+future+vision+of+simulation+in+health+care.">The future vision of simulation in health care.</a> Qual Saf Health Care. 13, i2-i10 (2004).</li><li>Salas, E., Wilson, K. A., Burke, C. S., Priest, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+simulation-based+training+to+improve+patient+safety:+what+does+it+take?.">Using simulation-based training to improve patient safety: what does it take?.</a> Jt Comm J Qual Patient Saf. 31 (7), 363-371 (2005).</li><li>McGaghie, W. C., Siddall, V. J., Mazmanian, P. E., Myers, J., Committee, A. C. o. C. P. H. a. S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lessons+for+continuing+medical+education+from+simulation+research+in+undergraduate+and+graduate+medical+education:+effectiveness+of+continuing+medical+education:+American+College+of+Chest+Physicians+Evidence-Based+Educational+Guidelines.">Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.</a> Chest. 135 (3 Suppl), 62S-68S (2009).</li><li>Paige, J. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-fidelity,+simulation-based,+interdisciplinary+operating+room+team+training+at+the+point+of+care.">High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care.</a> Surgery. 145 (2), 138-146 (2009).</li><li>Moitra, V. K., Gabrielli, A., Maccioli, G. A., O'Connor, M. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anesthesia+advanced+circulatory+life+support.">Anesthesia advanced circulatory life support.</a> Can J Anaesth. 59 (6), 586-603 (2012).</li><li>Ziewacz, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Crisis+checklists+for+the+operating+room:+development+and+pilot+testing.">Crisis checklists for the operating room: development and pilot testing.</a> J Am Coll Surg. 213 (2), 212-217 (2011).</li><li>O'Sullivan, O. E., O'Sullivan, S., Hewitt, M., O'Reilly, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Da+Vinci+robot+emergency+undocking+protocol.">Da Vinci robot emergency undocking protocol.</a> J Robot Surg. 10 (3), 251-253 (2016).</li><li>Arriaga, A. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+trial+of+surgical-crisis+checklists.">Simulation-based trial of surgical-crisis checklists.</a> N Engl J Med. 368 (3), 246-253 (2013).</li></ol>

将这一课程纳入培训需要遵守上文概述的《议定书》。确保通过手训练紧急脱位的技术方面, 以及界定或人员的作用, 对成功的培训至关重要。所有三次培训前模拟、汇报和培训后模拟都可能需要, 以确保学习者获得最大的利益。
应该努力创造尽可能现实的学习环境。虽然使用就地环境不是强制性的, 但鼓励在实际或环境中确定任何后勤障碍或潜在安全威胁, 以阻止紧急脱位的?...

这项培训的目的是提高机器人外科医生的信心, 知识和熟练程度的执行紧急脱位的机器人系统, 并提高外科医生的能力, 带领 interprofessional 团队通过有效的在紧急脱位时明确划定的角色的沟通。尽管手术室里有大量的人员和设备, 但缺乏管理这些危机的经验1,2。目前在线课程工作的培训要求和短时间的监考案例让许多外科医生觉得他们的训练不足3。不管这些不充分的感觉, 以前的研究已经证实, 外科医生在他们的职业生涯中至少会遇到1或紧急情况4。改进这些不足感的策略包括增加模拟训练的使用5。仿真训练与外科教育6是密不可分的。先前的研究已经确定, 基于仿真的团队培训是帮助学习者克服外科教育中认知和行为差距的宝贵工具, 并且作为一种工具, 可以让学员在与其他团队成员的会话中有能力演示知识和沟通技巧的基线, 同时改进模拟练习和任务汇报后的性能4,7,8,9, 10,11。
为了改进机器人危机管理, 已开发了各种模拟器培训方案1,12,13。尽管已经有许多研究团队培训的影响, 但对于复杂或方案4的研究分析培训缺乏。在复杂或紧急情况下, 核对清单和通过有效的沟通明确划定的作用是至关重要的。在机器人外科手术中, 缺乏可用的文献概述协议或培训此过程14。模拟已证明有效的验证检查表中使用的手术室危机, 以改善外科护理15。在这里, 我们提出了一个培训课程, 让机器人外科医生开发必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。本课程的实施在现场环境中进行三次以上, 如图 1所示, 可用于为认证提供培训、演示技能, 并且在任何医院都能轻松重现, 并具有机器人系统。

<table border="0" cellpadding="0" cellspacing="0" width="573">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">ZOE Gynecologic Simulator</td>
			<td style="width:71px;">Gaumard</td>
			<td style="width:119px;">S504.100</td>
			<td style="width:167px;">Incisions placed above umbilicus and in right and left lower quadrants large enough to pass trochars through. Vessels as detailed below. Tubing used to make aorta spliting into common iliacs as well as inferior vena cava.&#160;</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">da Vinci Si Robotic System</td>
			<td style="width:71px;">Intuitive Surgical</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Tubing from Atrium Water Seal Chest Drain</td>
			<td style="width:71px;">Atrium</td>
			<td style="width:119px;"></td>
			<td>Suction tubing removed an colored</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Chest Tube Y-connector&#160;</td>
			<td style="width:71px;">Sorin Group</td>
			<td style="width:119px;">050525-000</td>
			<td>Connected to suction tubing for split from descending aorta to right and left iliac vessels</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Reeve&#39;s Oil Colour Paint Set</td>
			<td style="width:71px;">Reeves</td>
			<td style="width:119px;"></td>
			<td>Coloring for venous and arterial vessel (Red and Blue)</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Rust-oleum Clear Coat Enamel Spray</td>
			<td style="width:71px;">Rust-oleum</td>
			<td style="width:119px;"></td>
			<td>Coating for protection of vessels coloring</td>
		</tr>
	</tbody>
</table>

emergency undocking in robotic surgery: a simulation curriculum

以下是一个训练平台, 让机器人外科医生开发出必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。在对外科医生的传统机器人训练中, 对机器人系统进行初步的入门培训时提供了一个简短的基于 web 的执行紧急脱位的概述。在这一过程中, 没有为手术室 (或) 人员划定跨学科角色的培训。这里所提供的培训使用形成性模拟和汇报, 接着是一个讲座。对于模拟, 一个改良的妇科模拟器被覆盖在一个陡峭的向健位置与大多数妇科腹腔镜手术一致。训练躯干是修改使用的油管挂钩的红食品彩色 IV 流体压力袋, 用于模拟灾难性的船只受伤的需求。定位在整个手术室设置是一个 interprofessional 团队组成的嵌入式标准化人员 (ESPs), 以履行职能的循环护士, 擦洗护士, 麻醉师和床边协助外科医生。机器人外科医生被提出的情况下, 有必要紧急脱位, 并给予控制的机器人仪器。该方案在成功完成紧急移除后终止, 或在五分钟内由于该案件的突发性质。在模拟过程中, 将向您提供关于紧急脱位、必要设备、故障排除技术和手术室人员角色培训步骤的简报。学习者被介绍了一个简短的演讲 reemphasizing 的材料提出的报告为他们自己的自学。这项培训的结果是, 更多的时间进入病人, 改善知识, 信心和完成关键行动, 并可以复制在大多数机构。所有的机器人外科医生都应该能够在这个关键的干预中表现出能力。课程的限制是为培训目的进入现场环境的能力。

通过将此课程纳入图 1和图 2中概述的脱位协议, 在机器人辅助手术训练过程中, 我们的研究显示了信心、知识和关键的全面改善。由外科医生执行的操作, 如图 3所示。在参加课程之前, 所有参加者都收集了关于知识和信心的基线测量。20题多选考试和6项李克特置信度范围从非常不舒服到非常舒适提供了这?...

Watch this Scientific Journal Video about Emergency Undocking in Robotic Surgery: A Simulation Curriculum at JoVE.com

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

机器人手术中的紧急脱位: 一个模拟课程

这一训练平台的目的是让机器人外科医生开发必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。培训包括利用技术和设备来执行紧急脱位, 以及为这种情况划分角色。

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

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