Training in laparoscopic gynaecological surgery is challenged by the boundaries of the traditional apprentice-tutor model and the ethical objective of limiting the complication rates. The European ...Academy for Gynaecological Surgery (The Academy) has focussed their scientific work in the last 6 years on defining the standards a future laparoscopist must meet in order to operate, either independently or under supervision. The Laparoscopic Skills Testing and Training (LASTT) model has been proved feasible and to have face and construct validity. Furthermore, it has been proved in this model that basic laparoscopic psychomotor skills (LPS) require proper training and that proficiency in those skills cannot be acquired by only training more complex tasks, such as intra-corporeal knotting. The observation that the LPS are retained over long periods is very important for the structure of a training program, being therefore comparable to swimming or biking skills. The data gathered over these years by the Academy, and supported by reports from other groups, strongly recommend that an in-house in vitro model for training and testing laparoscopic skills should be available in every teaching centre. Only those who reach proficiency in these practical skills, and who demonstrate sufficient theoretical knowledge, will have access to the “Green Card” that defines the minimum requirements prior to training for surgical procedures with patients. Following this strategy, we postulate that the morbidity and mortality rate associated with laparoscopic procedures in training centres will be reduced and the efficiency of one-to-one teaching will be improved.
Izpopolnjevanje v spretnosti endoskopske ginekološke kirurgije vodijo meje, ki jih postavlja model tradicionalnega odnosa vajenec-mojster ter etični cilj operirati s čim manj zapletov. Evropska akademija za ginekološko kirurgijo (The Academy) je zadnjih 6 let svoje znanstveno delo osredotočila na definiranje standardov, ki jih mora izpolnjevati bodoči laparoskopski kirurg, da bo lahko operiral samostojno ali pod nadzorom. Model LASTT (The Laparoscopic Skills Testing and Training) je pokazal, da je izvedljiv, da ima realno vrednost in da pokaže tudi na razlike med različno sposobnimi operaterji. Z modelom je bilo tudi dokazano, da je za osnovne laparoskopske psihomotorične veščine (LPS) treba vaditi in da se do izvrstnosti v teh veščinah ne da priti z vadbo bolj zapletenih veščin kot je intra-korporealno vezanje vozlov. Izjemno pomembna za strukturo tečajev vadb je ugotovitev, da LPS znanje zadržimo dolgo časa, kar lahko primerjamo z obvladovanjem veščin kot sta vožnja kolesa ali plavanja. Podatki, ki jih je v zadnjih letih zbrala The Academy in jih podpirajo rezultati drugih skupin, zelo priporočajo, da ima vsak center za poučevanje svoj model za vadbo in testiranje laparoskopskih veščin. Le tisti, ki bodo dokazali, da so vešči v praktičnih veščinah in bodo pokazali dovolj teoretičnega znanja, bodo imeli dostop do »Zelene karte«, ki definira minimalne zahteve pred začetkom operiranja bolnikov. Naš postulat je, da če sledimo tej strategiji, se bo obolevnost in smrtnost po laparoskopskih operacijah v centrih za edukacijo zmanjšala in učinkovitost učenja eden-na-enega izboljšala.
PDF