藉由腹腔鏡縫合課程使住院醫師得到與熟練腹腔鏡縫合技巧，並增強信心

研究動機與背景：由於年輕住院醫師在臨床很少有機會主刀，甚至資深的住院醫師也只負責當第一助手或是掌鏡，沒有太多機會操作腹腔鏡縫合，也缺乏系統性的教學與練習。研究目的： 探討台灣微創手術訓練中心(Institut de Recherche contre les Cancers de l’Appareil Digestif Taiwan, IRCAD Taiwan)腹腔鏡縫合課程，對於住院醫師縫合技術獲取、熟練與信心建立之評估。研究方法：從2017年到2020年7次課程中，共165位國內外外科系住院醫師參與了為期三天的腹腔鏡縫合課程，包含課堂理論演講、實驗室實際模具操作拿針、持針、調整角度、打外科結、體腔外組織實驗與活體實驗豬模擬手術等等之練習。在課程開始前，測驗並記錄學員們使用腹腔鏡縫合技巧一個打外科結的時間，並讓學員們填寫課前信心問卷；在課程結束後，同樣測驗並記錄學員使用腹腔鏡縫合技巧打一個外科結的時間，並填寫課後信心問卷。所得資料使用paired t-test做統計分析。研究結果:前測與後測之時間比較，後測縮短了56.73秒，p<0.001，信心分數之比較，課後信心分數增加了2.91，P<0.001。結果顯示此課程對於腹腔鏡縫合技巧之熟練與增強信心，是有幫助的。個別7個梯次中，只有2018年之前後測統計學上沒有顯著之差異，其餘6組皆有統計學上之顯著差異。結論與建議:不管有無外科手術之經驗，外科系住院醫師們皆能透過三天的腹腔鏡縫合課程，在花費有限、可近性高、效率佳且考慮病人安全的狀況下，能獲得腹腔鏡縫合技巧之熟練與增強日後主刀手術時之信心。

Background: Young surgeons usually play the role of assistants and have little chance to operate an operation. There is currently no validated educational model to evaluate and teach basic Laparoscopic suturing skills that is widely accessible to surgical residency training programs.Objectives: The objective was to evaluated skill acquisition, proficiency and confidence increasing in residency after laparoscopic suturing curriculum launched by IRCAD Taiwan.Methods and Materials: 165 residents with nationality of Taiwan or other country in different hospitals in surgery underwent a 3-day curriculum in 7 batches separately from 2017 to 2020 consisting of lectures, hand-on sessions with dry box and live animal practice. They underwent baseline and post-training evaluation including time of finishing a surgical tie with laparoscope and confidence level after completion of the course. The baseline and post-training values were compaired with paired T-test for skill acquisition, proficiency increasing and confidence evaluation. Results: Comparison of the pre-test and post-test suture time reduction (-56.73 seconds; P<0.001) and confident level increase (+2.91; P<0.001) were noted which revealed a significant learning outcome of laparoscopic suture curriculum. In each course, suture time reduction is noted except the curriculum at 2018 Oct. Conclusion and Suggestion: Residents with or without surgical experience can all acquired basic laparoscopic skills via this 3-days laparoscopic suture curriculum, which allows simple laparoscopic surgical techniques to be carried out in an inexpensive, accessible fashion with patient safety circumstances, which makes these residents more confident at real operation afterward.