Separation, ligation, suturing, and hemostasis are the four basic techniques of surgery, but laparoscopic surgery is quite different from traditional open surgery in terms of operational techniques. Therefore, to master the operation technology of laparoscopic surgery, it is necessary to undergo technical training and have a process of gradual adaptation.
Laparoscopic surgical training should include three processes: simulation training, animal testing, and clinical practice.
(1) Simulation training: The laparoscopic surgery training box is used to simulate the human abdominal cavity, and the laparoscopic surgery technique training is performed through the monitor image. At present, most domestic laparoscopic training centers have such equipment, and some training centers also have a laparoscope electronic simulation operating system.
Laparoscopic simulation training should include the following:
1 hand-eye coordination training: put 2 plastic plates in the training box, one of which contains a lot of soybean-sized rubber particles or plastic granules (can also be replaced by peanuts and other items), under the monitor barrier image, Use a grasping forceps to clamp the items on the plate one by one to another; or put a picture with various graphics into the training box and cut the figure with a tissue scissors. It is required to be free to collide around in the operation, and try to be stable, accurate, light and fast. The mirror protector should adjust the lens and focal length at any time according to the operation of the surgeon, so that the image of the field is always clear and accurate.
2 Orientation adaptation training: put the wooden board nailed with wooden nails in the training box, use the grasping forceps to wrap the rubber bands on each wooden nail purposefully, or perform similar operations with the silk thread. Repeated practice to continuously improve the orientation ability of laparoscopic operation;
3 Tissue separation training: Put rubber, grape, orange or skinned chicken in the training box, and use blunt separation and sharp separation training with grasping forceps, scissors, electric hooks, etc.
4 clip and suture knot training: the treatment of cystic duct or blood vessel in laparoscopic surgery is usually completed with a clip clamp or suture knotting, different animal tissues can be used for the clip and suture knot training;
5 simulated cholecystectomy training: pig liver with gallbladder can be selected, placed in the training box, the electric knife electrode is placed, and the cholecystectomy training is performed according to the procedure of human cholecystectomy.
(2) Animal experiment: After completing the above simulation training, the animal with anatomical structure close to the human body is selected for laparoscopic animal experiment, and the training of cholecystectomy and appendectomy is completed. The animals usually used are pigs, dogs or rabbits. However, due to conditions such as equipment and funding, animal experiments can only be carried out in training centers with good conditions, which is difficult to promote.
(3) Clinical practice: After laparoscopic theoretical knowledge learning, simulation training and animal experiments, the basic theory and basic technical operation of laparoscopic surgery have been comprehensively mastered. On this basis, clinical practice can be entered.
Clinical practice usually consists of three phases:
1 observation of clinical surgery: This is the initial stage of clinical practice, you can further experience and feel the whole process of laparoscopic surgery by watching surgical video and on-site observation surgery;
2 clinical assistant stage: generally should be an assistant to a physician with rich experience in laparoscopic surgery, usually as a mirror helper, and then as the first assistant. During the operation, you should carefully understand and understand every operation of the operator. After the operation, you should carefully consider it, so that you can master the technical operation of the laparoscope as soon as possible.
3 clinical operation stage: After completing 10 to 20 times of laparoscopic surgery assistants, and meeting the qualified requirements, the patient can gradually transition to the surgery.
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