Soot S J, Eshraghi N, Farahmand M, Sheppard B C, Deveney C W
Department of Surgery, Oregon Health Sciences University, and the Portland Veterans Administration Medical Center, 97201, USA.
Arch Surg. 1999 Mar;134(3):278-81; discussion 282. doi: 10.1001/archsurg.134.3.278.
Two of us (B.C.S. and C.W.D.) began performing laparoscopic fundoplication in 1992. We have always designated the resident as the operating surgeon.
To determine the time necessary for both experienced surgeons and residents to become proficient in laparoscopic fundoplication.
The medical records of 241 consecutive patients undergoing laparoscopic fundoplication were reviewed. This period started with the implementation of the procedure in January 1992 and ended in March 1998. For 3 consecutive years, residents were given a questionnaire regarding their confidence in performing laparoscopic fundoplication.
Laparoscopic fundoplication was attempted in 241 patients and completed in 203 patients (84%). Comparing the first 25 attempted laparoscopic fundoplications with the second 25, there were 14 conversions (56%) vs 4 conversions (16%) (P<.01). Average operative times decreased from 236 to 199 minutes (P<.05), and the intraoperative complication rates were 5 (20%) and 1 (4%), respectively. Subsequently, the conversion rate stabilized at 2%. The operative time continued to decline to an average of 99 minutes for the last 25 laparoscopies. Senior residents and recent graduates returning the questionnaire performed an average of 112 laparoscopic procedures, including 15.7 laparoscopic fundoplications. They felt comfortable with the procedure after performing an average of 10.6 operations.
The learning curve is very steep for the first 25 laparoscopic fundoplications for experienced surgeons. However, improvements, as judged by decreases in operative time, conversion rate, and intraoperative complications, continue to occur after 100 cases. Under supervision, residents can become comfortable with this procedure after about 10 to 15 procedures.
我们两人（B.C.S.和C.W.D.）于1992年开始开展腹腔镜胃底折叠术。我们一直指定住院医师作为主刀医生。
确定经验丰富的外科医生和住院医师熟练掌握腹腔镜胃底折叠术所需的时间。
回顾了241例连续接受腹腔镜胃底折叠术患者的病历。这段时间从1992年1月该手术实施开始，至1998年3月结束。连续3年，向住院医师发放了一份关于他们对实施腹腔镜胃底折叠术信心的问卷。
241例患者尝试进行腹腔镜胃底折叠术，203例（84%）完成手术。将最初尝试的25例腹腔镜胃底折叠术与接下来的25例进行比较，中转开腹的有14例（56%），而接下来的25例中为4例（16%）（P<0.01）。平均手术时间从236分钟降至199分钟（P<0.05），术中并发症发生率分别为5例（20%）和1例（4%）。随后，中转开腹率稳定在2%。最后25例腹腔镜手术的平均手术时间继续降至99分钟。回复问卷的高年资住院医师和刚毕业的医生平均进行了112例腹腔镜手术，其中包括15.7例腹腔镜胃底折叠术。他们在平均进行10.6例手术后对该手术感到得心应手。
对于经验丰富的外科医生来说，最初的25例腹腔镜胃底折叠术学习曲线非常陡峭。然而，在100例手术后，从手术时间、中转开腹率和术中并发症的减少情况判断，仍持续有进步。在监督下，住院医师在进行大约10至15例手术后就能熟练掌握该手术。
