Evidenz, Verfügbarkeit und Zukunftsvisionen der Simulation in der Allgemein- und Viszeralchirurgie

Zusammenfassung

Übung macht den Meister – ein Spruch, den sicherlich jeder schon gehört hat. Das Üben von Chirurginnen und Chirurgen jeder Weiterbildungsstufe kann nachweislich zu einem Teil an Simulatoren absolviert werden. Dieses Training außerhalb des Operationssaales und unabhängig von Patienten ist sowohl ethisch als auch finanziell sinnvoll. Obwohl die Effektivität von Simulation in der Chirurgie mehrfach erwiesen wurde, ist ein Simulationstraining in Deutschland bisher kein verpflichtender Bestandteil der chirurgischen Facharztweiterbildung. Simulation umfasst dabei ein sehr breites Spektrum hinsichtlich Anwendung, Aufwand und Kosten. Die vorliegende Arbeit gibt einen Überblick über die Systeme und deren Einsatzgebiete und Zielgruppe. Der Fokus soll auf den gängigen verfügbaren Systemen liegen und mögliche Vor- und Nachteile herausarbeiten. Praktische Fertigkeiten stehen dabei im Vordergrund und alle 3 Säulen der Allgemein- und Viszeralchirurgie – konventionelle Techniken, Laparoskopie und Robotik – werden berücksichtigt. Simulatoren erzielen für sich genommen jedoch keine Kosten-Nutzen-Effektivität. Erst durch ein standortspezifisches strukturiertes Weiterbildungskonzept, in dem weiterbildungsstufengerechtes Simulationstraining mit entsprechender Einteilung im Operationssaal eng miteinander verzahnt werden, kann das volle Potenzial einer solchen Investition genutzt werden. Basisfertigkeiten sollten immer vor Ort trainiert werden können. Komplexe Simulationssysteme sind je nach finanzieller Ausstattung realisierbar oder sollten aufgrund der deutlichen Mehrkosten im Verbund oder für überregionale Kurse angeschafft werden. Die Techniken der immersiven virtuellen Realität in Kombination mit künstlicher Intelligenz und Deformationsalgorithmen werden für die Zukunft der Simulation sicherlich eine entscheidende Rolle spielen, wobei zunächst die Nutzung der verfügbaren Systeme ein primäres Ziel sein muss. Die Integration von Simulation in die Facharztweiterbildung ist dabei anzustreben, nicht zuletzt, um die Finanzierung zu erleichtern.

Abstract

Practice makes perfect – a saying that everyone has certainly heard. Surgeons of all levels of training can demonstrably practice to some extent on simulators. This training outside the operating theatre and independent of patients makes sense, both ethically and financially. Although the effectiveness of simulation in surgery has been proven several times, simulation training is not a mandatory part of surgical specialist training in Germany. Simulation covers a very wide range in terms of application, effort and costs. This review is intended to give an overview of the systems and their areas of application and the target group. The focus lies on the commonly available systems and possible advantages and disadvantages. Practical skills are in the foreground and all three pillars of general and visceral surgery – conventional techniques, laparoscopy and robotics – are taken into account. However, simulators alone do not achieve cost-benefit effectiveness. The full potential of such an investment can only be exploited with a site-specific, structured training concept in which simulation training according to the post-graduate year and appropriate allocation to surgeries in the operating room are closely interlinked. It should always be possible to train basic skills on site. The significant additional costs for complex simulation systems are possible, depending on the financial resources, or should be purchased in a network or for national courses. The techniques of immersive virtual reality in combination with artificial intelligence and deformation algorithms will certainly play a decisive role for the future of simulation, whereby the use of the available systems must be a primary goal. The integration of simulation into specialist training should be striven for, not least in order to justify the costs.

Schlüsselwörter

Simulation - chirurgische Weiterbildung - Laparoskopie - robotische Chirurgie - Nachwuchsförderung - Abdominalchirurgie

Keywords

simulation - surgical education - robotic surgery - laparoscopy

Publication History

Received: 01 May 2023

Accepted after revision: 14 June 2023

Article published online:
10 August 2023

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