Study On The Application Of 3D Printing Model In The Teaching Of Laparoscopic Anti Reflux Surgery

Objective The incidence rate of gastroesophageal reflux disease(GERD)is increasing year by year.Laparoscopic anti reflux surgery(LARS)is an important method for treating gastroesophageal reflux disease.However,compared with foreign countries,the rate of operation in China is low.One of the main reasons is that there are few units,limited teaching opportunities and low teaching efficiency.3D printing technology is widely used in the field of medicine.The development of 3D printing technology provides a new method for surgery teaching,but it has not been reported in laparoscopic anti reflux surgery teaching.In this study,3D printing model was used in the teaching of laparoscopic anti reflux surgery for the first time,and its application value was discussed.Methods A case of gastroesophageal reflux disease(GERD)with hiatal hernia in Zhejiang Provincial People's Hospital was collected for CT digital imaging and communication files.Image analysis and 3D reconstruction were performed using E3D digital medical modeling software v17.06.Cura 4.4.1,an open-source slicing software,was used to process the special silica gel material for 3D printing.The silica gel material for esophagus and stomach was purplish red,shore hardness was 0 a,tear strength was 5.0n/mm,and tensile strength was 1.5MPa.The silica gel material for diaphragm was flesh color,shore hardness was 0 a,tear strength was 4.8n/mm,and tensile strength was 2.0MPa.Import the data into the slicing software for slicing and generate a 3D printer recognizable G code.From the self-developed double nozzle silica gel printer printing model,we can see about 4cm esophageal hiatus hernia,and then install the abdominal wall contour device in inflated state to form a 3D printing laparoscopic anti reflux surgery training model.From January 2018 to September 2019,40 further education doctors in the center were randomly divided into 3D printing model teaching and training group(observation group)and traditional teaching training group(control group),20 in each group.The observation group used 3D printing laparoscopic anti reflux operation training model for theoretical teaching and operation training,while the traditional teaching group used slide and other traditional teaching methods for theoretical teaching and traditional laparoscopic training simulator for operation training.The two groups were compared in terms of training device score,theoretical assessment score,surgical skill objective structured assessment(OSATS)score,operation time before and after training,teaching evaluation score and other indicators,and statistical analysis was carried out to draw conclusions.Results?Compare the two groups of trainer scores:The overall impression(P=0.002),color and color(P=0.011),texture material(P=0.001)and training effect(P=0.012)of the four items were compared.The scores of 3D printing group were higher than those of the traditional group,with statistical difference(P<0.05).There was no significant difference in flexibility and elasticity(P=0.225)between the two groups(P>0.05).?Compare the theoretical assessment scores of the two groups:The results of LARS anatomical theory(P=0.002),LARS operation procedure(P=0.003),LARS complications and treatment(P=0.018)and the total score of theoretical assessment(P=0.001)were higher in the 3D printing group than in the traditional group,with statistical difference(P<0.05).There was no statistical difference in the GERD disease theory achievement between the observation group and the control group(P>0.05).?Compare the OSATS scores of the two groups:There was a significant difference in OSATS score before and after training between 3D printing group and traditional group(P=0.000);there was no significant difference in OSATS score before and after training between 3D printing group and traditional group(P=0.824);After training,the OSATS score in the 3D printing group was higher than that in the traditional group(P=0.007).?Compare the operation time of two groups:Comparison of average stitching time per stitch:compared with the average stitching time per stitch before and after training in 3D printing group,the average stitching time per stitch after training was shorter than that before training,with a statistically significant difference(P=0.000);compared with the average stitching time per stitch before and after training in traditional group,the average stitching time per stitch after training was shorter than that before training,with a statistically significant difference(P=0.000);after training There was no significant difference between the three-dimensional printing group and the traditional group(P=0.177);after training,the three-dimensional printing group had a shorter suture time than the traditional group(P=0.000).Comparison of operation completion time:in 3D printing group,the operation completion time before and after training was shorter than that before training,the difference was statistically significant(P=0.003);in traditional group,the operation completion time before and after training was shorter than that before training,the difference was statistically significant(P=0.017);the operation completion time before training was 3D printing There was no significant difference between the two groups(P=0.617);the operation completion time of 3D printing group was shorter than that of traditional group(P=0.037).?Compared with the scores of teaching evaluation in the two groups:In the comparison of Likert scale scores of learning interest and harvest improvement in teaching evaluation indexes,the 3D printing group was higher than the traditional group,the difference was statistically significant(P<0.05).Compared with the Minnesota scale of teaching satisfaction,the 3D printing group was higher than the traditional group,the difference was statistically significant(P=0.002).Conclusion?The model of laparoscopic antireflux surgery based on image data,digital medicine and 3D printing technology is more lifelike,intuitive,three-dimensional and reusable.It can be used in surgery teaching,providing more opportunities for surgery training,and has broad application prospects.?The 3D printing model used in the teaching of laparoscopic anti reflux surgery can shorten the learning curve,reduce the operation time,improve the operation skills,and obtain satisfactory teaching results.?Compared with the traditional teaching mode,3D printing model can enhance the learning interest,improve the teaching quality and efficiency,and improve the teaching effect and satisfaction.