关于使用3D打印模型加强缝合技术手术训练的随机队列研究-动脉网

A randomized cohort study on the use of 3D printed models to enhance surgical training in suturing techniques

Nature 等信源发布 2025-01-03 16:49

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可切换为仅中文

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Abstract

摘要

Three-dimensional (3D) printed surgical models provide an excellent surgical training option to closely mimic real operations to teach medical students who currently rely largely on visual learning aided with simple suturing pads. There is an unmet need to create simple to complex surgical training programs suitable for medical students.

三维（3D）打印的手术模型提供了一个极好的手术训练选项，可以紧密模拟真实手术，以教授目前主要依靠简单缝合垫辅助视觉学习的医学生。创建适合医学生的简单到复杂的外科培训计划的需求尚未得到满足。

A prospective cohort study was conducted on a group of 16 6th year students. They were randomly divided into two groups for suture training on a basic training pad or on unique 3D-printed intestinal anastomosis models. After 4 weeks of open and laparoscopic surgical training, exams were performed on the standardized 3D-printed model at the end of each stage to assess surgical performance including surgical time and scores.

对16名六年级学生进行了一项前瞻性队列研究。他们被随机分为两组，在基本训练垫或独特的3D打印肠吻合模型上进行缝合训练。经过4周的开放式和腹腔镜手术训练后，在每个阶段结束时对标准化的3D打印模型进行检查，以评估手术表现，包括手术时间和评分。

Both groups had similar skills before the start of each stage. In stage 1, both groups showed comparable learning performance, but the 3D model group performed better in Exam 1. In stage 2, the 3D model group took more time but showed significant improvements and outperformed the pad group in Exam 2 in both performance scores and time.

在每个阶段开始之前，两组都有类似的技能。在第一阶段，两组的学习成绩相当，但3D模型组在考试1中表现更好。在第二阶段，3D模型组花费了更多的时间，但表现出显着的改进，并且在考试2中的成绩和时间上都优于pad组。

Post-training questionnaires indicated increased interest in surgery and technical training among students using 3D models. Realistic 3D-printed models benefit surgical training, expected to become integral in teaching operative skills and techniques to medical students..

培训后问卷显示，使用3D模型的学生对手术和技术培训的兴趣增加。逼真的3D打印模型有利于手术训练，有望成为医学生手术技能和技术教学的组成部分。。

Introduction

导言

The start of clinical rotations in 6th year in a medical program is usually a momentous period for most medical students, where they are allowed to take on the title of medical doctor. During this period, it is important to have a holistic view that involves exposing students to the entirety of the surgical care pathway by incorporating theoretical and practical teaching of operative skills.

对于大多数医学生来说，六年级开始临床轮换通常是一个重要的时期，他们可以获得医生的头衔。在此期间，重要的是要有一个整体的观点，通过结合手术技能的理论和实践教学，让学生了解整个手术护理途径。

. Over the years, this unaddressed learning need has resulted in a gap between the theoretical knowledge that medical students are taught and the limited opportunities to apply that theoretical learning to patient care

多年来，这种未解决的学习需求导致医学生所教授的理论知识与将理论学习应用于患者护理的机会有限之间存在差距

. This gap usually results in the often unaddressed lack of the training of operative skills which may result in inevitable feelings among medical students of unpreparedness for a career as a surgeon

这种差距通常导致经常无法解决的缺乏手术技能培训的问题，这可能会导致医学生不可避免地感到对外科医生的职业没有准备

Simulation plays an important role in medical student education. Indeed, simulation-based training in surgical education has rapidly developed during the 21st century

仿真在医学生教育中起着重要作用。事实上，基于模拟的外科教育培训在21世纪得到了迅速发展

. While some aspects of training occur outside the OR, and because trainees are working fewer clinician hours, surgery residents and medical school graduates are still expected to reach the same technical proficiency as their predecessors. Simulation-based training can expose medical students to surgical techniques earlier and thereby improve their operative skills and interest.

虽然培训的某些方面发生在手术室之外，并且由于受训者的临床医生工作时间较少，但外科住院医师和医学院毕业生仍有望达到与前辈相同的技术水平。基于模拟的培训可以使医学生更早地接触外科技术，从而提高他们的手术技能和兴趣。

. Benchtop models are one of the oldest models used as tools: they are inexpensive, allow familiarity, and provide unlimited practice opportunities when used appropriately, thereby translating into good operative skills on live patients. These models range from computerized simulation, virtual reality, and foam pads, in addition to the use of human cadavers, porcine cadavers, and live animal models (rat, rabbit, dog).

。这些模型包括计算机模拟，虚拟现实和泡沫垫，以及使用人体尸体，猪尸体和活体动物模型（大鼠，兔子，狗）。

A new alternative model using a 3D-printed dry model based on actual CT- modeled reconstruction from a human bilio-enteric anastomosis as a guide for laparoscopic bile-enteric anastomosis as reported by Wang et al..

Wang等人报道了一种新的替代模型，该模型使用基于人体胆肠吻合术的实际CT建模重建的3D打印干燥模型作为腹腔镜胆肠吻合术的指南。。

has proven to be a suitable alternative with good outcomes for operative skills training.

已被证明是一种合适的替代方法，对操作技能培训具有良好的效果。

If new medical graduates are required to perform procedures independently, such as skin suturing, basic training in surgical skills ideally needs to be taught and evaluated previously. Even for newly qualified doctors (undergoing postgraduate training), the provision of training in surgical skills could flatten the steep learning curve for the residency program and provide standardized training for all newly graduated doctors.

如果要求新的医学毕业生独立进行手术，如皮肤缝合，理想情况下需要事先教授和评估外科技能的基本培训。即使对于新获得资格的医生（正在接受研究生培训），提供外科技能培训也可以拉平住院医师计划的陡峭学习曲线，并为所有新毕业的医生提供标准化培训。

Simulation training is highly valued by medical students when learning practical surgical skills, and medical schools are encouraged to teach basic surgical skills using simulation whenever possible.

医学生在学习实际手术技能时高度重视模拟训练，鼓励医学院尽可能使用模拟来教授基本的手术技能。

Despite advancements in surgical education, there remains a gap in practical training for medical students. This study aims to bridge this gap by introducing 3D-printed models for surgical training. Using a prospective cohort study according to the STROCSS 2021

尽管外科教育取得了进步，但医学生的实践训练仍然存在差距。这项研究旨在通过引入用于手术训练的3D打印模型来弥合这一差距。根据STROCSS 2021使用前瞻性队列研究

and CONSORT 2010

和CONSORT 2010

, we measured the subjects’ scores during stepwise training with subsequent standardized exams to measure outcomes through a validated assessment scale. We also sought to encourage and deepen medical students’ understanding of surgical training and to provide a new model for the future training of novice doctors..

，我们在逐步训练期间测量了受试者的分数，随后进行了标准化考试，以通过经过验证的评估量表来衡量结果。我们还试图鼓励和加深医学生对外科培训的理解，并为未来的新手医生培训提供新的模式。。

Materials and methods

材料和方法

Ethical approval and research registration unique identifying number (UIN)

道德批准和研究注册唯一识别号（UIN）

The study was reviewed and approved by the Ethics Committee of Zhejiang Provincial People’s Hospital (KY2024012) on 25/01/2024. The study was in accordance with the Helsinki Declaration of 1964 and later versions. The study has been registered in the Chinese Clinical Trial Registry on 05/02/2024. UIN: ChiCTR2400080695.

该研究于2024年1月25日由浙江省人民医院伦理委员会（KY2024012）审查并批准。该研究符合1964年《赫尔辛基宣言》及其后版本。该研究已于2024年2月5日在中国临床试验注册处注册。UIN：ChiCTR2400080695。

The first participant was recruited on 07/02/2024, and all participants completed their training on 12/04/2024..

第一名参与者于2024年2月7日被招募，所有参与者于2024年4月12日完成了培训。。

Participants

参与者

A total of 16 eligible 6th year medical students participated in this study. Their age was 25.0 ± 1.0 years old, and there were 12 males and four females. All were required to be right-handed to avoid any potential influence of handedness because we used surgical instruments that were classically designed for right-handed individuals.

共有16名符合条件的六年级医学生参加了这项研究。他们的年龄为25.0±1.0岁，男性12例，女性4例。所有人都被要求使用右手，以避免利手的任何潜在影响，因为我们使用的手术器械是为惯用右手的人设计的。

They had no previous experience with a surgical rotation and had no experience or training in suturing or other operative skills. All participants completed an informed consent and a short questionnaire regarding their views on surgical training before and after the training. Participants consented to the anonymous processing of the collected data..

他们以前没有手术旋转的经验，也没有缝合或其他手术技能的经验或培训。所有参与者都完成了一份知情同意书和一份简短的问卷，了解他们在培训前后对外科培训的看法。参与者同意匿名处理收集的数据。。

Material

材料

The small intestine and bile duct were the primary components of the jejunojejunostomy anastomosis and biliary-enteric anastomosis that were used for the stepwise training. The 3D data (which provided the content for the transfer of patient data) were based on the CT imaging of a healthy patient and were printed using a dual-head silicone printer.

小肠和胆管是空肠吻合术和胆肠吻合术的主要组成部分，用于逐步训练。3D数据（为患者数据的传输提供内容）基于健康患者的CT成像，并使用双头硅胶打印机打印。

E3D digital medical modeling software v17.06 (Central South E3D Digital Medical and Virtual Reality Research Center, China) was used for boundary segmentation and 3D reconstruction, and the model structure was streamlined through manual editing. Open source Cura 4.4.1 slicing software (Ultimaker, USA) was used to create the 3D-printed slices.

使用E3D数字医学建模软件v17.06（中南E3D数字医学与虚拟现实研究中心，中国）进行边界分割和三维重建，并通过手动编辑简化模型结构。开源Cura 4.4.1切片软件（Ultimaker，USA）用于创建3D打印切片。

The material was made of silicone and specialized for 3D printing..

该材料由硅胶制成，专门用于3D打印。。

Training curriculum

培训课程

Stage 1

第1阶段

All participants executed four suturing tasks on the given equipment using the basic pad (Fig. 1A) in the following order during the first week:

所有参与者在第一周内使用基本垫（图1A）在给定设备上按以下顺序执行了四项缝合任务：

Knot tying by hand: participants tied a reef knot (also called a square knot) consisting of an underhand and an overhand throw.

手工打结：参与者打了一个暗礁结（也称为方形结），由下手和上手组成。

Transcutaneous (skin) suturing and knot tying with instruments: participants executed one transcutaneous suture on the incision of their pad and tied the suture using an instrument tie technique.

经皮（皮肤）缝合和器械打结：参与者在其垫的切口上进行一次经皮缝合，并使用器械打结技术打结。

Vertical mattress suturing—suture and knot tying with instruments: participants executed one vertical mattress suture on the incision of their pad and tied the suture using an instrument tie.

垂直床垫缝合缝合和器械打结：参与者在他们的垫子切口上执行一条垂直床垫缝合线，并使用器械领带打结。

Continuous suturing with knots tied at each end: participants were asked to tie a knot at one end of the board, then apply 4 cm of continuous simple, over-and-over suturing of the edges of the “wound”, and then tie a knot at the end. The knots were tied with an instrument tie.

连续缝合，两端打结：要求参与者在木板的一端打结，然后在“伤口”的边缘反复缝合4厘米的连续简单，然后在最后打结。绳结是用乐器领带打结的。

After one week of training, the participants were randomly divided into two groups according to the randomly generated numbers by observers using computers (eight in each group). The participants in the general group continued the training using the suture pad. The participants in the 3D-printed model group transitioned to training on a 3D-printed intestine model for an end-to-end anastomosis (Fig. 1B).

训练一周后，根据观察者使用计算机随机生成的数字，将参与者随机分为两组（每组八名）。普通组的参与者继续使用缝合垫进行训练。3D打印模型组的参与者转变为在3D打印的肠模型上进行端到端吻合的训练（图1B）。

The training involved freehand knot tying, simple interrupted sutures tied with an instrument tie, vertical mattress sutures, and continuous sutures. After 4 weeks of open surgery training, all participants completed Exam 1 by performing a biliary-enteric anastomosis using the model at the end of stage 1 (Fig. 1C)..

训练包括徒手打结，用器械领带打结的简单间断缝合线，垂直床垫缝合线和连续缝合线。经过4周的开放手术训练，所有参与者在第1阶段结束时使用该模型进行胆肠吻合术，完成了考试1（图1C）。。

Fig. 1

图1

The models used in this study. (

本研究中使用的模型。(

) the basic pad. (

)基本垫。(

B类

) 3D-printed end-to-end intestinal anastomosis model. (

)3D打印端到端肠吻合模型。(

C级

) 3D-printed biliary-enteric anastomosis model. (

)3D打印胆肠吻合模型。(

) 3D-printed side-to-side anastomosis model.

)3D打印的侧对侧吻合模型。

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Stage 2

第2阶段

After completing the open training and examination above, all subjects went on to Stage 2 and were randomly divided into two groups again for a 4 week training in laparoscopic surgery (eight in each group). An abdominal simulator was placed on a flat desktop, with a 3D-printed model or pad placed below.

完成上述开放式训练和考试后，所有受试者进入第二阶段，并被随机分为两组，再次进行为期4周的腹腔镜手术训练（每组8人）。将腹部模拟器放置在平坦的桌面上，下面放置3D打印模型或垫。

12 mm trocars were placed on the center, left, and right sides of the abdominal simulator for placing laparoscopic instruments. The middle Trocar was used to place a laparoscopic camera, which could be connected to an external screen. The trocars on both sides were used to place laparoscopic instruments, such as forceps, needle holders, and laparoscopic scissors.

将12毫米套管针放置在腹部模拟器的中心，左侧和右侧，用于放置腹腔镜器械。中间的套管针用于放置腹腔镜摄像机，该摄像机可以连接到外部屏幕。两侧的套管针用于放置腹腔镜器械，例如镊子，针座和腹腔镜剪刀。

(Fig. 2) One group of subjects underwent training involving laparoscopic simple sutures, vertical mattress sutures, and continuous suture practice with an instrument tie using the pad under laparoscopy visualization. The other group of subjects underwent surgical training on a 3D-printed end-to-end intestinal anastomosis model, including simple sutures, vertical mattress sutures, and continuous sutures.

（图2）一组受试者接受了包括腹腔镜简单缝合线，垂直床垫缝合线和在腹腔镜可视化下使用垫进行仪器扎带的连续缝合练习的训练。另一组受试者在3D打印的端到端肠吻合模型上接受了手术训练，包括简单缝合线，垂直床垫缝合线和连续缝合线。

After 4 weeks of laparoscopic surgery training, all participants completed Exam 2 by performing a laparoscopic side-to-side anastomosis on the model shown in Fig. 1D at the end of stage 2. (Fig. 3).

经过4周的腹腔镜手术训练后，所有参与者在第2阶段结束时，通过在图1D所示的模型上进行腹腔镜侧对侧吻合来完成考试2。（图3）。

At the beginning of each stage, an experienced senior surgeon conducted the teaching and suture demonstrations on the use of open and laparoscopic instruments.

在每个阶段开始时，一位经验丰富的高级外科医生进行了关于使用开放式和腹腔镜器械的教学和缝合演示。

Fig. 2

图2

Laparoscopy visualization set up and surgical training.

腹腔镜可视化设置和手术训练。

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Fig. 3

图3

Flowchart of the study.

研究流程图。

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Measures

措施

All details from all operations were recorded and downloaded by the simulation trainer and scored by two experienced surgeons. Each participant’s performance was scored at the study site, as the primary endpoints. Each participant’s training time was recorded, as the secondary endpoint. The observer was blinded to the specific order of the observed video.

所有手术的所有细节都由模拟培训师记录和下载，并由两名经验丰富的外科医生评分。每个参与者的表现都在研究地点进行评分，作为主要终点。记录每个参与者的训练时间，作为次要终点。观察者不知道观察到的视频的具体顺序。

The investigator’s scale for evaluating the trainee’s technical maneuvers was based on the OSATS.

研究者评估学员技术操作的量表基于OSATS。

scale and a suture-specific form according to the relevant reported literature

根据相关报道的文献，鳞片和缝合线的特定形式

. (Table

（表

S1级

-（笑声）

)

Data analyses

数据分析

SPSS software 25.0 was used for the subsequent data analyses and processing. The data with a normal distribution were verified by a two-tailed

随后的数据分析和处理使用SPSS软件25.0。正态分布的数据通过两尾验证

-test; the data with a skewed distribution were statistically analyzed by a two-sample rank sum test. Values of

-；通过两样本秩和检验对偏态分布的数据进行统计分析。的值

< 0.05 were considered statistically significant. The results from the statistical analyses were entered into GraphPad Prism 10.0, and related charts were drawn. The data were calculated as mean ± standard deviation.

<0.05被认为具有统计学意义。将统计分析的结果输入GraphPad Prism 10.0，并绘制相关图表。数据计算为平均±标准偏差。

Results

结果

Baseline training and exam scores

基线培训和考试成绩

At the beginning of the open training (Stage 1), the initial performance of all subjects was evaluated on the basic pad. The performance scores of the basic pad group and the 3D-printed model group were 69.4 ± 11.2 and 74.6 ± 8.5 (full score of 160) (

在开放式训练（第1阶段）开始时，所有受试者的初始表现都在基本pad上进行了评估。基本垫组和3D打印模型组的表现得分分别为69.4±11.2和74.6±8.5（满分160）(

= 0.313), with times of 9.3 ± 1.9 and 9.1 ± 1.2 min (

==0.313），时间分别为9.3±1.9和9.1±1.2±1.2(

= 0.735). The fourth training session was used as the baseline before the group training. The performance scores of the basic pad group and the 3D-printed model group were 94.8 ± 4.6 and 94.2 ± 4.2 (

==0.735）。第四次训练课程被用作小组训练之前的基线。(

= 0.829), with times of 7.4 ± 1.4 and 8.2 ± 0.8 min (

==0.829），时间分别为7.4±1.4和8.2±0.8±min(

= 0.222). There was no statistically significant difference in the scores and times between the two groups. For Exam 1, the performance scores of the basic pad group and the 3D-printed model group were 28.3 ± 1.7 and 31.6 ± 1.7 (full score of 40) (

= 0.222）。两组之间的分数和次数无统计学差异。对于考试1，基本pad组和3D打印模型组的表现得分分别为28.3±1.7和31.6±1.7（满分40分）(

= 0.001). The time spent on Exam 1 in the basic pad group and the 3D-printed model group was 15.1 ± 2.2 and 14.9 ± 2.45 min (

0.001）。基本pad组和3D打印模型组在考试1上花费的时间分别为15.1±2.2和14.9±2.45分钟(

= 0.818), respectively.

=0.818），分别。

During the Stage 2 laparoscopic simulation training, the initial performance of all subjects was evaluated on the basic pad. The performance scores of the basic pad group and the 3D-printed model group were 50.2 ± 1.8 and 50.1 ± 1.7 (full score of 120) (

在第二阶段腹腔镜模拟训练期间，在基本pad上评估了所有受试者的初始表现。基本垫组和3D打印模型组的表现得分分别为50.2±1.8和50.1±1.7（满分120）(

= 0.902), respectively. The time spent was 29.6 ± 1.7 and 29.7 ± 1.6 min (

=0.902），分别。花费的时间分别为29.6±1.7和29.7±1.6分钟(

= 0.905). There were no statistically significant differences in the scores and times between the two groups. For Exam 2, the performance scores of the basic pad group and the 3D-printed model group were 25.6 ± 1.6 and 30.0 ± 1.9;

= 0.905）。两组之间的分数和次数没有统计学上的显着差异。对于考试2，基本pad组和3D打印模型组的表现得分分别为25.6±1.6和30.0±1.9；

< 0.001). The time they spent was 35.2 ± 8.5 and 26.7 ± 3.0 min (

他们花费的时间分别为35.2±8.5和26.7±3.0分钟(

= 0.018), respectively. There were statistically significant differences between the two groups in both the scores and time spent (Table

=0.018），分别。两组在得分和花费的时间上均存在统计学上的显着差异（表

Table 1 Baseline training and exam scores.

表1基线训练和考试成绩。

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Scores at the different training stages

不同训练阶段的得分

In stage 1 of open surgery training, the performance scores of the basic pad group (full score of 160) increased from 91.8 ± 7.3 to 132.1 ± 10.7 and the time spent decreased from 7.3 ± 1.01 to 5.6 ± 0.80 min. The performance scores (full score of 35) of the 3D-printed model group increased from 15.6 ± 2.6 to 29.9 ± 1.3, and the time spent decreased from 21.7 ± 5.9 to 13.5 ± 2.3 min (Fig. 4)..

在开放手术训练的第一阶段，基本pad组的表现评分（满分160分）从91.8±7.3增加到132.1±10.7，花费的时间从7.3±1.01减少到5.6±0.80分钟。3D打印模型组的表现得分（满分35分）从15.6±2.6提高到29.9±1.3，花费的时间从21.7±5.9减少到13.5±2.3分钟（图4）。。

Fig. 4

图4

The score and time used in stage 1.

第一阶段使用的分数和时间。

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In Stage 2, the laparoscopic surgery training, the performance scores of the basic pad group (full score of 120) increased from 55.0 ± 3.9 to 77.7 ± 5.64, and the time spent decreased from 26.3 ± 4.2 to 21.4 ± 5.5 min. The performance scores (full score of 40) of the 3D-printed model group increased from 20.1 ± 1.5 to 30.2 ± 1.45 and the time spent decreased from 38.6 ± 8.1 to 23.5 ± 2.8 min (Fig. 5)..

在第二阶段，腹腔镜手术训练中，基本pad组的表现评分（满分120分）从55.0±3.9提高到77.7±5.64，花费的时间从26.3±4.2减少到21.4±5.5分钟。3D打印模型组的表现得分（满分40分）从20.1±1.5增加到30.2±1.45，花费的时间从38.6±8.1减少到23.5±2.8分钟（图5）。。

Fig. 5

图5

The score and time used in stage 2.

第二阶段使用的分数和时间。

Full size image

全尺寸图像

Questionnaire before and after training

培训前后问卷调查

All subjects completed a questionnaire survey consisting of five questions (1–10 points, 10 points for maximum), including questions about their views on the use of models for surgical training and evaluation of the comfort and potential of using 3D-printed models (Table

所有受试者均完成了一项由五个问题组成的问卷调查（1-10分，最多10分），其中包括有关他们对手术训练模型使用的看法以及对使用3D打印模型的舒适性和潜力的评估的问题（表

). The scores of the subjects answering the question on the importance of training increased from 8.1 ± 1.1 to 8.9 ± 1.1 after training (

)。训练后，回答训练重要性问题的受试者的分数从8.1±1.1增加到8.9±1.1(

= 0.029).

== 0.029).

Table 2 Questionare scores.

表2问题是分数。

Full size table

全尺寸表

The discomfort of the subjects

受试者的不适

All the trainees completed the clinical theoretical study and were able to understand and participate in the experiment. All the subjects were taught by professional and experienced surgeons before the formal training. During the training process, an observer was responsible for evaluating the physical and mental state of the subjects.

所有学员都完成了临床理论学习，能够理解并参与实验。在正式培训之前，所有科目均由专业且经验丰富的外科医生教授。在训练过程中，观察员负责评估受试者的身心状态。

Neither the basic pad nor the 3D-printed models involve potential biological hazards. All surgical instruments were thoroughly disinfected and properly prepared before use. No puncture injuries occurred in this experiment, and no subjects reported any discomfort in the group survey 1 month after the training..

基本pad和3D打印模型都不涉及潜在的生物危害。所有手术器械在使用前都经过彻底消毒和适当准备。在这个实验中没有发生穿刺伤，训练后1个月的小组调查中没有受试者报告任何不适。。

Discussion

讨论

In this study, it appeared that through early exposure to 3D-printed models, trainees could obtain a better training experience for the necessary operative skills that will be required of fully trained doctors once they graduate, which is not only reflected in improvements to their skill scores and reduced operation time, but also in the improvement of medical students” awareness of the importance of surgical training, the strengthening of interest in the field of surgery, and the recognition of the potential of 3D-printed models for future surgical training.

在这项研究中，似乎通过早期接触3D打印模型，受训人员可以获得更好的培训经验，以获得毕业后经过全面培训的医生所需的必要手术技能，这不仅反映在他们的技能得分提高和手术时间缩短，而且还体现在提高医学生对手术培训重要性的认识，增强对手术领域的兴趣，以及认识到3D打印模型在未来手术培训中的潜力。

Use of the 3D-printed model takes more time than the basic pad, because 3D printing simulates a realistic surgical fit, which includes controlling the position of the overall model, mastering the next surgical steps, and selecting the stitching angle that trainees need to independently control, but the spending of more time in training statistically significantly improved the acquisition surgical skills.

。

The results showed that in stage 2, the 3D printing model group experienced a significant improvement in performance. After only 1–2 rounds of training, their results were on par with those of the control group, who trained for four rounds. They can break through the platform period faster and thus acquire surgical skills more quickly and effectively..

结果表明，在第二阶段，3D打印模型组的性能有了显着提高。仅经过1-2轮训练后，他们的成绩与对照组相当，对照组训练了四轮。他们可以更快地突破平台期，从而更快，更有效地获得手术技能。。

Simulation training replicates the outward qualities of specific objects or processes to realistically depict various clinical scenarios. Traditional simulation for operative suturing focuses on repetitive technical skills using standard suture pads, which some view as insufficient for comprehensive beginner training.

模拟训练复制特定对象或过程的外观质量，以真实地描述各种临床场景。传统的手术缝合模拟侧重于使用标准缝合垫的重复技术技能，一些人认为这不足以进行全面的初学者训练。

This repetitive nature can become monotonous and disconnected from real clinical situations, leading to decreased student interest and engagement, ultimately affecting training effectiveness and surgical practice. However, junior trainees often have limited opportunities to enhance their abilities in traditional operating room settings.

这种重复性可能变得单调，与实际临床情况脱节，导致学生兴趣和参与度下降，最终影响培训效果和手术实践。然而，初级学员在传统手术室环境中提高能力的机会往往有限。

. Incorporating laparoscopic surgery training into medical education is essential for providing students with a foundational understanding of minimally invasive techniques, which have become indispensable in modern surgical practice. For medical students who have yet to decide on their future specialty, the objective of basic laparoscopic skill training is not to rapidly transform them into proficient laparoscopic surgeons, but rather to enhance fundamental skills such as hand-eye coordination, spatial awareness, and surgical dexterity—skills that are valuable across all medical disciplines.

.将腹腔镜手术培训纳入医学教育对于为学生提供微创技术的基础理解至关重要，微创技术已成为现代外科实践中不可或缺的。对于尚未决定未来专业的医学生来说，基本腹腔镜技能培训的目标不是要将他们迅速转变为熟练的腹腔镜外科医生，而是要提高基本技能，如手眼协调，空间意识和手术灵活性技能，这些技能在所有医学学科中都很有价值。

Additionally, this training fosters a broader understanding of surgical principles, ultimately contributing to the development of well-rounded clinical capabilities. Regulatory bodies like the Accreditation Council for Medical Education (ACGME) in the United States increasingly require surgeons to demonstrate proficiency through surgical simulation programs, including laboratory-based operative training.

此外，这种培训有助于更广泛地了解手术原理，最终有助于发展全面的临床能力。美国医学教育认证委员会（ACGME）等监管机构越来越多地要求外科医生通过手术模拟计划（包括基于实验室的手术培训）证明其熟练程度。

In regions such as China, high-quality simulation training for medical students and junior doctors remains limited.

在中国等地区，医学生和初级医生的高质量模拟培训仍然有限。

. Simulation training is widely utilized in various surgical specialties, including digestive

.模拟训练广泛应用于各种外科专业，包括消化科

, thoracic, cardiovascular surgery

, orthopedics, and ophthalmology

，骨科和眼科

. Surgeons can enhance their skills and achieve proficiency more rapidly, especially in laparoscopic and robotic surgery, by using continuously improving simulators

通过使用不断改进的模拟器，外科医生可以更快地提高技能和熟练程度，尤其是在腹腔镜和机器人手术中

The use of 3D-printed models is anticipated to replace cadavers as the primary medium for surgical training

预计使用3D打印模型将取代尸体作为手术训练的主要媒介

. These models, based on CT scan data from healthy individuals and adjusted for material composition, closely mimic actual tissues and provide realistic tactile feedback

这些模型基于健康个体的CT扫描数据，并根据材料组成进行了调整，紧密模仿了实际组织，并提供了逼真的触觉反馈

. From a financial perspective, recent advancements in printing technology and the availability of more affordable materials have significantly reduced the cost of 3D-printed models. In this study, we employed cost-effective materials and optimized printing protocols, enhancing the scalability and feasibility of the approach.

从财务角度来看，最近印刷技术的进步和更实惠的材料的可用性大大降低了3D打印模型的成本。在这项研究中，我们采用了具有成本效益的材料和优化的打印协议，增强了该方法的可扩展性和可行性。

Moreover, the educational benefits, coupled with a reduced reliance on animal or cadaver models, provide a compelling justification for the initial investment. From an environmental standpoint, the adoption of more sustainable practices in 3D printing is essential. The models used in this study are designed for reuse over 8–15 cycles, which helps minimize material waste.

此外，教育效益，加上减少对动物或尸体模型的依赖，为初始投资提供了令人信服的理由。从环境的角度来看，在3D打印中采用更可持续的做法至关重要。本研究中使用的模型设计用于8-15个循环的重复使用，这有助于最大程度地减少材料浪费。

While disposable models may be useful in specific training contexts, their environmental impact raises concerns regarding sustainability. Moving forward, it is crucial to explore cost-effective and sustainable materials, as well as recycling mechanisms, such as incorporating replaceable components into the model design.

虽然一次性模型在特定的培训环境中可能有用，但它们的环境影响引起了人们对可持续性的担忧。展望未来，探索具有成本效益和可持续性的材料以及回收机制至关重要，例如将可替代组件纳入模型设计。

and investigating the potential for re-melting materials for future prints. These strategies aim to balance educational objectives with environmental responsibility.

并研究未来印刷品重新熔化材料的潜力。这些策略旨在平衡教育目标与环境责任。

Surgical training that incorporates 3D-printed models may require more stringent and standard specific steps, such as a focus on the exact needle insertion site, especially in laparoscopic training where the tissue is visualized by a camera and cannot be “felt”. The appropriate points can be marked on the model to help set the standard site for needle placement, which may help medical students to better master standardized operative skills.

结合3D打印模型的手术训练可能需要更严格和标准的特定步骤，例如专注于确切的针头插入部位，特别是在腹腔镜训练中，组织通过相机可视化并且不能“感觉到”。。

What needs to be recognized and emphasized to the learner is that there is no “set final surgical achievement ” in the real surgical world, and surgeons are constantly practicing using qualified technology to perfect their surgical skills. For this reason, the use of set markers for simulation training may affect how medical students improve their surgical skills through continuous trial and error and it may even be conducive to an earlier, more rapid appropriate flattening of the learning curve..

需要向学习者认识和强调的是，在现实的外科世界中没有“最终的手术成就”，外科医生正在不断练习使用合格的技术来完善他们的手术技能。因此，使用设定标记进行模拟训练可能会影响医学生如何通过不断的尝试和错误来提高他们的手术技能，甚至可能有助于更早，更快速地适当平坦学习曲线。。

Hand dominance is a concern that is rarely mentioned by surgeons. Manual dexterity appears to have an impact on the final result, whether the suturing is done in the open or laparoscopic setting. The ultimate ambidexterity of left-handed trainees is superior to that of right-handed trainees after dexterity training.

手部优势是外科医生很少提及的问题。无论缝合是在开放式还是腹腔镜下进行，手动灵活性似乎都会影响最终结果。经过灵巧性训练后，左手受训者的最终双能性优于右手受训者。

. In this experiment, the subjects were required to be right-handed and to use the right hand for tying knots to avoid any potential influence of handedness on the use of surgical instruments designed originally for right-handed individuals. Laparoscopic left-handed knot tying can be advantageous when suturing in tight spaces to minimize possible peripheral tissue damage from a right-handed knot technique such as closure of the esophageal hiatus.

在这个实验中，受试者被要求使用右手，并使用右手打结，以避免利手对最初为右手个体设计的手术器械的使用产生任何潜在影响。当在狭窄的空间缝合时，腹腔镜左手打结可能是有利的，以最大程度地减少右手打结技术（例如闭合食管裂孔）可能对周围组织的损伤。

We believe that this is an area of operative training that warrants further research and exploration in the future..

我们相信这是一个手术训练领域，值得在未来进一步研究和探索。。

The 3D visualization system is an advanced innovation that enhances surgeons’ precision when handling complex surgical scenarios, thereby reducing unnecessary injuries caused by differences in visual and tactile perception

3D可视化系统是一项先进的创新，它可以提高外科医生在处理复杂手术场景时的精确度，从而减少由于视觉和触觉感知差异引起的不必要的伤害

. Several studies have compared the roles of 3D visualization systems and 2D views in surgical training

几项研究比较了3D可视化系统和2D视图在手术训练中的作用

. While 3D visualization systems have shown a positive impact on accelerating skill acquisition to some extent

虽然3D可视化系统在一定程度上对加速技能获取产生了积极影响

, some research has revealed that novices trained exclusively with 3D visualization systems tend to perform worse in 2D-view scenarios

，一些研究表明，仅接受3D可视化系统培训的新手在2D视图场景中的表现往往较差

. Moreover, these systems have not demonstrated improved outcomes when translated into clinical tasks

此外，这些系统在转化为临床任务时并未显示出改善的结果

, posing a challenge for beginners acquiring foundational surgical skills. As a result, our study did not incorporate the use of 3D visualization systems. On one hand, performing laparoscopic surgeries with a 2D view remains the most commonly adopted approach in operating rooms (OR) today. For beginners, learning and adapting to the 2D laparoscopic view is a critical first step.

，对初学者获得基础手术技能提出了挑战。因此，我们的研究没有纳入3D可视化系统的使用。一方面，使用2D视图进行腹腔镜手术仍然是当今手术室（OR）中最常用的方法。对于初学者来说，学习和适应2D腹腔镜视图是至关重要的第一步。

Therefore, using 3D-printed models designed for 2D views better aligns with the training needs of novice surgeons. On the other hand, the cost of 3D visualization systems can limit their use in non-tertiary hospitals, further constraining their widespread application in training programs. Nevertheless, the 3D visualization system possesses significant potential.

因此，使用为2D视图设计的3D打印模型更好地符合新手外科医生的培训需求。另一方面，3D可视化系统的成本可能会限制其在非三级医院的使用，进一步限制其在培训计划中的广泛应用。然而，3D可视化系统具有巨大的潜力。

We believe its integration with 3D-printed models could enhance surgical training outcomes and facilitate skill acquisition, particularly for more advanced procedures. We look forward to seeing this system applied in training programs for more experienced surgeons, such as residents and fellows, to prepare them for more complex surgical scenarios..

我们相信它与3D打印模型的集成可以提高手术训练效果并促进技能获得，特别是对于更先进的手术。我们期待着看到该系统应用于更有经验的外科医生（如住院医生和研究员）的培训计划中，为他们应对更复杂的手术场景做好准备。。

This study has some limitations. First, although one group was exposed to the 3D printed model while the other was not, the focus of this study was on mastering the suture technique and the ability to transfer fundamental skills to a new scenario. We assessed suture skills by using scenarios of varying difficulty levels, which could avoid certain biases.

。首先，尽管一组人接触了3D打印模型，而另一组人没有，但本研究的重点是掌握缝合技术以及将基本技能转移到新场景的能力。我们通过使用不同难度的场景来评估缝合技能水平，这可以避免某些偏见。

Furthermore, the study did not ascertain the level of interest among medical students in pursuing a career in surgery. This aspect is noteworthy as those intending to pursue surgery may have been more inclined to participate compared to those with different career aspirations. Additionally, it is recommended that future research includes a follow-up to assess the subsequent performance of participating medical students in the surgical field or in their chosen medical/surgical specialty.

。这方面值得注意，因为与那些有不同职业抱负的人相比，那些打算接受手术的人可能更倾向于参与。此外，建议未来的研究包括后续评估参与医学生在外科领域或其选择的医学/外科专业的后续表现。

Although the investigators in this study were from a single center, this approach allowed us to more closely manage the technical evaluations and the research environment. More research in surgical and operative training is worth exploring in the future to explore and promote more high-quality surgical training courses; future work could include the use of a more advanced and improved OSATS scale, including A-OSATS.

虽然这项研究的调查人员来自一个中心，但这种方法使我们能够更密切地管理技术评估和研究环境。未来值得探索更多的外科和手术培训研究，以探索和推广更多高质量的外科培训课程；未来的工作可能包括使用更先进和改进的OSATS量表，包括a-OSATS。

, and the contemporary scientific evaluation system based on the Messick Validity Framework training system

，以及基于梅西克有效性框架训练系统的当代科学评估系统

Conclusion

结论

The use of a highly realistic, 3D-printed model appeared to have unique advantages compared to the traditional training model for the operative training of medical students. The use of such more realistic models provides a good bridge for novice doctors to have hands-on contact with and understand real-world operative techniques, operations, and the operating room environment, both in open and laparoscopic settings.

与传统的医学生手术训练模型相比，使用高度逼真的3D打印模型似乎具有独特的优势。这种更真实的模型的使用为新手医生提供了一个很好的桥梁，可以在开放式和腹腔镜环境中亲自接触并了解现实世界的手术技术，手术和手术室环境。

Through regular staged surgical training for specific tasks, medical students can master basic suturing skills in both the open and laparoscopic approach in a more comprehensive and rapid fashion..

通过针对特定任务的定期分期手术训练，医学生可以更全面和快速地掌握开放式和腹腔镜手术的基本缝合技能。。

Data availability

数据可用性

All original data are available upon reasonable request to the corresponding authors.

所有原始数据均可根据通讯作者的合理要求获得。

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Acknowledgements

致谢

We thank the cooperation of the medical students who participated in this trial, colleagues from Zhejiang Provincial People’s Hospital and International Education College of Zhejiang Chinese Medical University who contributed to this research. We thank LetPub (www.letpub.com) for linguistic assistance and pre-submission expert review..

我们感谢参与这项试验的医学生，浙江省人民医院和浙江中医药大学国际教育学院的同事的合作，他们为这项研究做出了贡献。我们感谢LetPub（www.LetPub.com）提供的语言帮助和提交前的专家评审。。

Funding

资金

This work was supported by the fund of The Science and Technology Cooperation Project of Zhejiang Provincial Department of Science and Technology (2024C04027) and The Special Project for Key R&D Tasks of the Xinjiang Uygur Autonomous Region (Project No.2023B03010-1).

这项工作得到了浙江省科学技术厅科技合作项目基金（2024C04027）和新疆维吾尔自治区重点研发任务专项（项目编号2023B03010-1）的支持。

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Author notes

作者注释

These authors contributed equally: Zhihao Zhu and Sidney Moses Amadi.

这些作者做出了同样的贡献：朱志浩和西德尼·摩西·阿马迪。

Authors and Affiliations

作者和隶属关系

General Surgery, Cancer Center, Department of Hernia Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, 310014, China

杭州医学院浙江省人民医院（附属人民医院）疝外科肿瘤中心普外科，杭州310014

Zhihao Zhu, Jinlei Mao, Junfeng Hu & Zhifei Wang

朱志浩、毛金磊、胡俊峰和王志飞

International Education College, Zhejiang Chinese Medical University, Hangzhou, 310053, China

Sidney Moses Amadi & Nikhilkumar Jagadishbhai Parikh

西德尼·摩西·阿马迪_尼基尔库马尔·贾加迪什巴伊·帕里克

The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China

浙江中医药大学第二临床医学院，杭州310053

Menghui Zhou & Minjun Xia

周梦辉

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Zhihao Zhu

朱志浩

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西德尼·摩西·阿马迪

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认识周

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Minjun Xia

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Junfeng Hu

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Contributions

捐款

Zhihao Zhu and Sidney Moses Amadi contributed equally to this work. Zhihao Zhu writing—original draft, validation, formal analysis and methodology. Sidney Moses Amadi writing—original draft and visualization. Jinlei Mao, Minjun Xia and Menghui Zhou data curation. Nikhilkumar Jagadishbhai Parikh investigation.

朱志浩和西德尼·摩西·阿马迪对这项工作做出了同样的贡献。朱志浩撰写了原稿，验证，形式分析和方法论。西德尼·摩西·阿马迪（SidneyMosesAmadi）撰写原稿和可视化。。Nikhilkumar Jagadishbhai Parikh调查。

Junfeng Hu and Zhifei Wang contributed equally to this work. Junfeng Hu conceptualization, supervision and project administration. Zhifei Wang: conceptualization, resources, supervision, funding acquisition and writing—review & editing..

胡俊峰和王志飞对这项工作做出了同样的贡献。胡俊峰的概念化，监督和项目管理。王志飞：概念化，资源，监督，资金获取以及写作评论和编辑。。

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Junfeng Hu

胡俊峰

或

Zhifei Wang

王志飞

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Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Research registration unique identifying number (UIN)

研究注册唯一识别号（UIN）

The study has been registered in the Chinese Clinical Trial Registry in 05/02/2024.

该研究已于2024年2月5日在中国临床试验注册处注册。

UIN: ChiCTR2400080695.

ChiCTR2400080695。

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Zhu, Z., Amadi, S.M., Mao, J.

。

et al.