腹腔镜手术的基础

Fundamentals of Laparoscopic Surgery

(FLS)

                               
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Fundamentals of Laparoscopic Surgery (FLS) is a program of SAGES and the American College of Surgeons designed to teach and evaluate the knowledge, judgment, and skills fundamental to laparoscopic surgery, independent of the surgical specialty. World Laparoscopy Hospital has adopted the same module to train the surgeons and gynaecologists so that they should be able to perform the minimal access surgery themself after training.

The mission of this program is to to provide surgical trainees, fellows and practicing surgeons an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format; and to test cognitive, surgical decision-making, and technical skills, all with the goal of improving the quality of patient care.

Technical skills are essential to the practice of surgery. Performance in the skills laboratory should ultimately be predictive of performance in the clinical setting.They can be taught in the operating room and in the surgical skills laboratory. The use of simulators allows the development of reproducible curricula with measurement of performance using objective metrics.

FLS is a comprehensive web-based education module that includes a hands-on skills training component and assessment tool designed to teach the physiology, fundamental knowledge, and technical skills required in basic laparoscopic surgery.

The goal of those designing metrics for the simulation laboratory should be to establish measures that are consistent with those of high quality surgery in the operating room.It has undergone rigorous evaluation to ensure that the evaluation component meets appropriate standards to ensure the reliability and validity of the test.

FLS Objectives

• To improve the quality of care received by patients undergoing laparoscopic surgery
• To set minimum standards for basic cognitive and technical skills used in performing laparoscopic procedures
• To provide surgeons practicing laparoscopy with standardized didactic information on the fundamentals of laparoscopic surgery and a tool to assist in development of judgment and manual skills
• To create an objective quantifiable measure to assess knowledge, judgment and manual skills in basic laparoscopic surgery
• To make available to hospitals and institutions a validated tool to measure the knowledge and skills fundamental to the performance of laparoscopic surgery
  

The manual skills component is based on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) program. This component has been shown to meet standards for reliability (interrater, test–retest, and internal consistency) required for a high-stakes examination. Content, face, construct, and criterion validity have also been established through a series of experimental studies. FLS presents a comprehensive learning package that is inexpensive and of proven value for teaching minimally invasive surgery. Its unique contribution is the included validated assessment to ensure that those taking the program have demonstrated the requisite knowledge and skills fundamental to performing laparoscopic surgery.

                               
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Recognizing the importance of improving surgeon's technical skills and enhancing patient safety, as well as the need for on-site training and testing, World Laparoscopy Hospital provided same quality training on the protocol of FLS program which will bring quality training and testing in FLS directly to general surgery residency programs for the next three academic years.

World Laparoscopy Hospital is a leading minimal access surgery institute that creates innovative medical solutions for better patient outcomes and delivers value through clinical leadership and excellence. World Laparoscopy Hospital through FLS program provides signature guidelines for training, standards of practice and granting of privileges which promote patient safety and the best clinical outcomes. Developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) the Fundamentals of Laparoscopic Surgery program (FLS) includes cognitive and hands-on skills training components, and a validated assessment focusing on the physiology, fundamental knowledge, and technical skills required in basic laparoscopic surgery.

FLS program has been validated as a means to train and assess the physiology, fundamental knowledge and technical skills of basic laparoscopic surgery. FLS is a comprehensive, web-based (until recently the program was CD based) self-directed education module that includes a hands-on skills training component and assessment tool. The website study guides cover clinical theory, interactive patient scenarios and manual skills training. Participation in the program has the benefit of potentially enhancing the trainee’s laparoscopic surgical skills in a safe environment through access to state of the art surgical simulation, whilst aiding the WLH to address important curriculum and workforce issues.

The endotrainer boxes provide users the opportunity to practice basic laparoscopic skills, to improve hand-eye coordination and to increase manual dexterity with transferring objects, dissection and suturing. The hands-on portion of the exam consists of five surgical manual skills: peg transfer, precision cutting, placement and securing of ligating loop, simple suture with extracorporeal knot and simple suture with intracorporeal knot. Authorized proctors at the Simulation Center will help physicians practice these required skills repeatedly until competence and confidence is reached. Use of the Simulation Center as a practice location in a stress-free environment enables physicians to acquire the skills necessary to be successful on the exam after complition of the training.

This program provides a set of standardized tasks that are considered the 'gold standard' in surgical skill assessment. We at World Laparoscopy Hospital present a methodology for using all the tasks for surgical minimal access task performance evaluation. The Assessment Component is a two-part, proctored exam that covers cognitive knowledge and manual skills. The cognitive component is a timed, 75-question multiple-choice exam administered via computer. The manual skills component evaluates skills based on speed and accuracy of the surgeon’s maneuvers using the Laparoscopic Trainer Box. The purpose of this scientific design training is to determine performance retention after initial and ongoing Fundamentals of Laparoscopic Surgery (FLS) skills training.

As minimally invasive approaches join the mainstream of general surgery, The fundamentals of laparoscopic surgery (fls) based training is an integral component to the training of every general surgeon.