Name: 如何提高外科手術的靈巧性 | 有志於外科手術的醫生指南 (How to Improve Surgical Dexterity | Guide for Aspiring Surgeons)
Uploaded: 2021-10-09T18:40:22.000Z
Duration: 8 min 30 s

Surgeons are masters of their craft, using their hands and tools to cure ailments with

外科醫生是他們的手藝大師，用他們的手和工具來治療疾病，並以

基礎被動語態

immediacy. But to be proficient in the operating room, a high degree of dexterity is required.

即時性。但要在手術室裡熟練操作，需要高度的靈巧性。

Here's how to get there. Dr. Jubbal, MedSchoolInsiders.com

下面是如何到達那裡。Jubbal博士，MedSchoolInsiders.com

Why should you even care about improving your dexterity now? After all, isn't there plenty

為什麼你現在還要關心提高你的靈巧性？畢竟，不是有很多

of time to practice with your hands in the future, once you're a senior medical student

一旦你成為一名高年級的醫學生，你就有時間用你的手來練習。

or a surgical resident? There are a few reasons why you should prioritize it sooner than later:

或外科住院醫師？有幾個原因說明你應該儘早優先考慮它。

First, if you want to go into surgery, you'll need to impress your seniors and secure strong

首先，如果你想進入外科，你需要給你的前輩留下深刻印象，並確保強大的

letters of recommendation. While your letters aren't solely based on your technical skills,

推薦信。雖然你的信並不完全基於你的技術能力。

it definitely helps. Second, your opinion of surgery will be highly

它肯定有幫助。第二，你對手術的意見將是高度

influenced by your early experiences during your third year clerkships. If you struggle

受你三年級實習期間的早期經驗的影響。如果你掙扎著

with your hands, you're going to have a bad time. If you're highly proficient, I promise

用你的手，你會有一個糟糕的時間。如果你是高度熟練的，我保證

you it will be more fun and more rewarding. Also, I have seen a surgical resident who

你將會有更多的樂趣和更大的收穫。此外，我還見過一個外科住院醫生，他

had to repeat a year in residency two separate times due to lacking technical ability.

由於缺乏技術能力，不得不分別兩次重複一年的住院治療。

And third, surgical technique is taught primarily based on two factors: comfort and current

第三，手術技術的傳授主要基於兩個因素：舒適度和電流。

ability. Your attendings and residents will want to push you slightly past your comfort

能力。你的主治醫生和住院醫生會想讓你稍微超過你的舒適度。

zone in order to learn. If you demonstrate comfort and competence with the basics, you

為了學習，你可以在該區域進行學習。如果你表現出對基礎知識的舒適和能力，你就會

will be trusted with more fun tasks, beyond just retracting. The average medical student

將被信任為更多有趣的任務，不僅僅是縮回。普通的醫學生

and intern is just retracting, and maybe they'll be lucky to tie a knot or two. Statistics

和實習生只是收回，也許他們會幸運地打上一兩個結。統計數據

apply to populations, not to individuals, and it's on you to be the outlier. As a medical

適用於人群，而不是個人，而你要做的是成為一個例外。作為一個醫學

student, you can absolutely tie knots and suture on the majority of cases you scrub

學生，你絕對可以在大多數情況下打結和縫合。

into, but only by demonstrating technical proficiency.

成，但只能通過展示技術熟練程度。

Improving your skills in the operating room comes down to two main factors: mindset and

提高你在手術室的技能歸結於兩個主要因素：心態和

technical practice. Your mindset in your journey toward technical

技術實踐。你在走向技術的過程中的心態

mastery in the operating room comes down to whether you can find enjoyment in it. After

在手術室裡的掌握程度歸結為你是否能從中找到樂趣。之後

all, if you enjoy something, you're more likely to want to practice, put more time into it,

所有，如果你喜歡某件事，你就更有可能想去練習，投入更多的時間。

and accelerate your progression. If you don't enjoy it, then practicing will feel like pulling

並加速你的進步。如果你不喜歡它，那麼練習就會感覺像在拉動

teeth, and you'll spend less time and energy on it.

牙齒，而且你會在上面花費更少的時間和精力。

Therefore, the foundational mindset principle to improving your skills in the operating

是以，提高操作技能的基本心態原則是

room is to enjoy the process. How can we do so?

房間是為了享受這個過程。我們如何才能做到這一點？

If you initially hate it, it's usually because you don't feel very good at it, and the ratio

如果你最初討厭它，通常是因為你覺得自己不是很擅長，而比例

of effort to skill progression is skewed. Keep at it, and dive deep. Once getting past

努力與技能進步的比例是有偏差的。繼續努力，並潛入深處。一旦通過了

the initial hump, most students are able to find some level of enjoyment in honing their

在經歷了最初的坎坷之後，大多數學生都能在磨練自己的過程中找到某種程度的樂趣。

surgical skills. The pursuit of mastery can be incredibly rewarding,

外科技能。追求精湛的技術可以帶來令人難以置信的回報。

particularly in areas where you can see measurable improvement. Tying surgical knots and suturing

特別是在你能看到可衡量的改善的領域。打手術結和縫合

aren't as measurable as your body fat or strength in the gym, but you can find ways of tracking

這並不像你在健身房裡的體脂或力量那樣可以衡量，但你可以找到追蹤的方法。

progress. You could track the time it takes you to tie 10 knots. If you used to be slow

進展。你可以跟蹤你打10節的時間。如果你以前很慢

and tie sloppy knots, you'll be stoked when you're faster and have perfectly symmetric

和打馬虎結，當你的速度更快並且擁有完美的對稱性時，你會感到興奮。

and tidy knots. And when your attending gives you more responsibility in the operating room,

和整齊的繩結。而當你的主治醫生在手術室裡給你更多的責任時。

you'll know you've gained their trust and demonstrated an upward trend in proficiency.

你就會知道你已經獲得了他們的信任，並表現出熟練程度的上升趨勢。

Finding an area of surgery that you truly enjoy will make the application of this skillset

找到一個你真正喜歡的外科領域將使這一技能的應用成為可能

that much more rewarding. Just like studying physics is more fun when you're able to apply

這將使你更有成就感。就像研究物理學在你能夠應用時更加有趣一樣

it to your passion of Formula 1 racing, practicing surgical skills knowing it will help you for

你對一級方程式賽車的熱情，練習外科技能，知道這將有助於你的工作。

your future career as an orthopedic or neurosurgeon makes it that much more enjoyable.

你未來的職業是骨科或神經外科醫生，這使你的職業更加令人愉快。

The technical practice in the operating room follows a simple stepwise progression.

手術室的技術實踐遵循一個簡單的逐步推進的過程。

As a medical student, you'll initially primarily be retracting. It's not necessarily easy,

作為一個醫科學生，你最初主要是要撤回的。這不一定容易。

it's definitely not fun, and it can often be tiring. That being said, get used to it,

這絕對不是一件有趣的事，而且常常會讓人感到疲憊。話雖如此，還是要習慣它。

get proficient at it, and don't complain. Understand why you're retracting and do your

熟練掌握它，不要抱怨。理解你為什麼要撤回，並做你的

best to make the surgeon's job easier. Reading up on the nature of the procedure beforehand

最好使外科醫生的工作更容易。事先閱讀有關手術性質的資料

can help you understand the rough order and progression of steps so you can anticipate

可以幫助你瞭解步驟的大致順序和進展情況，以便你可以預測到

steps and know what's going on. Next, you'll be tying knots, which is much

步驟，知道發生了什麼事。接下來，你將會打結，這是多

more complex and nuanced than most students expect. Good knots use the least amount of

比大多數學生所期望的更復雜、更細微。好的繩結使用最少的

suture to securely hold tissue. With too little suture or poor technique, the knot is likely

縫合，以牢固地固定組織。縫線太少或技術不佳，結很可能會

to fail, resulting in wound dehiscence, meaning the surgical incision comes apart after it's

失敗，導致傷口開裂，這意味著手術切口在完成後會破裂。

been stitched together. With too much suture, there's excess foreign body material in the

被縫合在一起。縫合得太多，就會有過多的異物在裡面。

patient, which results in suboptimal inflammation and infection risk.

病人，這導致了不理想的發炎和感染風險。

To practice knot tying, you'll need a knot tying board. I've linked some of my favorites

為了練習打結，你需要一塊打結板。我已經把我最喜歡的一些東西聯繫起來了

in the video description, as well as a playlist of videos I created covering each of the knots.

在視頻描述中，還有一個我創建的涵蓋每個結的視頻播放列表。

Start with a simple two-handed throw, ensuring your knots are square. Be slow and deliberate

從簡單的雙手投擲開始，確保你的繩結是正的。緩慢而謹慎地進行

with your movements to solidify foundational technique. Don't worry about adding speed

用你的動作來鞏固基礎技術。不要擔心增加速度

now, that'll naturally come later. Once you're proficient, make sure you can reverse your

現在，這自然會在以後出現。一旦你熟練掌握了，確保你能將你的

hands such that you can swap the roles of your dominant and non-dominant hands.

你可以將你的優勢手和非優勢手的角色互換。

Next, learn how to do one-handed throws. Your non-dominant hand will be stationary, holding

接下來，學習如何做單手投擲。你的非優勢手將是靜止的，拿著

one piece of the suture or string. The dominant hand will be doing the throwing motion. Again,

一塊縫合線或繩子。主導手將做投擲動作。再一次。

once you're proficient, switch hands and reverse the roles of your hands.

一旦你熟練掌握了，就換手，把你的手的角色換過來。

The reason it's critical to be well versed with both hands is that surgery is never as

熟練掌握兩隻手的原因是，手術從來沒有像現在這樣。

perfect as your practice environment. You'll be in a suboptimal position, or there will

完美作為你的實踐環境。你會處於一個次優的位置，或者會有

be equipment in the way, or the knot must be thrown deep in a body cavity. For these

如果有設備擋著，或者繩結必須打在體腔深處。對於這些

and other reasons, you should be well versed in various different knot tying techniques

和其他原因，你應該精通各種不同的打結技巧

and with both hands. While you practice, again focus on fundamentals

而且是用雙手。當你練習時，再次把重點放在基本面上

and go slowly. Every knot should be square without any air knots, meaning gaps in the

並慢慢進行。每個結都應該是正方形的，沒有任何空結，也就是說，有縫隙的結。

suture between knots. As you get more comfortable, you can experiment with slightly more advanced

在結與結之間進行縫合。隨著你變得更加舒適，你可以嘗試使用稍微高級的

techniques. For example, you use a slip knot when there's a small aperture limiting the

技巧。例如，當有一個小孔限制的時候，你會使用滑結。

distance you can pull apart the suture. Similarly, if there's tension across an incision, you

你可以拉開縫合的距離。同樣地，如果切口有張力，你可以

would use a surgeon's or friction knot, where you first do a slip knot to hold the tissue

將使用外科醫生結或摩擦結，首先做一個滑移結以固定組織。

together prior to the locking throw. You can practice these various scenarios with one

在鎖定投擲之前，一起進行。你可以用一個人練習這些不同的情況

of the knot tying kits I've linked below, as they simulate cavities and tension across

我在下面鏈接的打結工具包，因為它們模擬的是空洞和跨越的張力。

an incision. Once you've graduated from the multicolored

一個切口。一旦你從五彩斑斕的

string in your kit, you'll want to grab some actual suture or ties. Find expired ties in

在你的工具箱中，如果你想用繩索縫合，你就得拿一些實際的縫合線或領帶。找到過期的領帶，在

your hospital and continue your practice, but this time you can do it just about anywhere.

你的醫院，繼續你的實踐，但這一次你可以在任何地方做這件事。

I would do it on my water bottle handle while sitting in lecture and the drawstring of my

當我坐在教室裡時，我會在我的水瓶把手上做這個動作，而在我的抽繩上做這個動作。

scrub pants. And finally, grab some OR gloves and put cooking

擦洗褲。最後，拿起一些OR手套，把烹飪

oil on them to simulate the slippery and fluid filled environment that is surgery.

在他們身上塗上油，以模擬手術中的滑溜溜和充滿液體的環境。

The final skillset to practice is suturing. Again, you'll need a specialized kit, and

最後要練習的技能是縫合。同樣，你將需要一個專門的工具包，以及

I've included my favorites in the description. You'll need a needle driver, forceps, practice

我已經在描述中包括了我最喜歡的東西。你需要一個起針器、鑷子、練習

tissue, surgical scissors, and suture. Be sure to purchase a separate high quality needle

組織、手術剪刀和縫合線。一定要單獨購買一個高質量的針頭

driver, as the ones in suturing kits are almost always subpar.

司機，因為縫合工具箱中的幾乎總是不合格的。

Similar to knot tying, there's a logical progression to follow. You'll begin with simple interrupted

與打結類似，有一個邏輯上的進展可以遵循。你將從簡單的中斷開始

sutures. Again, slow down and focus on the fundamentals, with attack angle of 90 degrees

縫合。再次，放慢速度，專注於基本面，攻擊角度為90度

to the tissue, consistent spacing, depth, and tail length when you cut. Now is also

到組織、一致的間距、深度和切割時的尾部長度。現在也是

the time to practice instrument ties, which is where you tie knots using the needle driver.

有時間可以練習打工具結，也就是用針筒打結。

You'll then advance to other suturing techniques, including running subcuticular, deep dermals,

然後你將推進到其他縫合技術，包括運行皮下、深層真皮。

vertical mattress, horizontal mattress, and more.

立式床墊，臥式床墊，以及更多。

As I've covered on my Kevin Jubbal, M.D. channel, you should also be able to palm a needle driver.

正如我在我的Kevin Jubbal, M.D.頻道上所介紹的那樣，你也應該能夠掌好一個針狀驅動器。

Inserting your fingers into the finger holes is actually slower and limits your range of

將手指插入指孔實際上是比較慢的，而且限制了你的動作範圍。

motion. Palming the needle driver is a pro move that allows for better control, efficiency

運動。握住起針器是一個專業的動作，可以更好地控制，提高效率

of movement, and speed. As you get more comfortable with these various

的運動，和速度。當你對這些不同的

tools, you can practice flipping them backwards into your palm so you can still user your

工具，你可以練習將它們向後翻轉到你的掌心，這樣你仍然可以使用你的

thumb, index, and middle finger for other movements. Again, the operating room is all

拇指、食指和中指進行其他動作。同樣，手術室裡的所有

about efficiency of movement, and saving a few seconds by flipping the tool into your

關於運動的效率，以及通過將工具翻轉到你的位置來節省幾秒鐘。

palm rather than placing it down is another small way to further optimize.

掌而不放是進一步優化的另一個小方法。