Wang W N, Melkonian M G, Marshall R, Haluck R S
Department of Surgery, Hahnemann University, Philadelphia, Pennsylvania 19102, USA.
J Surg Res. 2001 Nov;101(1):1-3. doi: 10.1006/jsre.2001.6252.
Surgical resident education may contribute to increased operating time, thus increasing costs at teaching institutions. It is possible that junior residents, in particular, with less experience could contribute to longer operating times for laparoscopic cholecystectomy. We hypothesized that all general surgery residents, regardless of level of training and with proper supervision, could complete a laparoscopic cholecystectomy in a safe and timely fashion.
A retrospective study was performed using data collected from laparoscopic cholecystectomies completed under the supervision of one attending surgeon over a 2-year period. Operating times were recorded, the operating surgeon was identified, and cases were assigned an acuity level based on pathologic findings. Operative times were compared after dividing surgeons into three groups (junior residents, senior residents, and staff).
Seventy-one cases were entered into the study. There were no differences when comparing mean operating times among the three groups (P = 0.2, analysis of variance). The pathologic acuity in each group was similar (P = 0.8, Fisher's exact test). There was a difference when evaluating the operating times for the pathologic level of acuity (P = 0.002, Kruskal-Wallis test).
Resident level does not affect the operating time in performing laparoscopic cholecystectomy. The pathologic acuity of the gallbladders was distributed similarly for all three groups. There was a difference in mean operating time based on pathologic acuity. Laparoscopic cholecystectomy can be performed in a safe and efficient manner at a teaching institution.
外科住院医师培训可能会导致手术时间延长,从而增加教学机构的成本。特别是经验较少的初级住院医师,可能会导致腹腔镜胆囊切除术的手术时间更长。我们假设,所有普通外科住院医师,无论培训水平如何,在适当的监督下,都能安全、及时地完成腹腔镜胆囊切除术。
进行一项回顾性研究,使用在一位主治医生监督下于两年内完成的腹腔镜胆囊切除术所收集的数据。记录手术时间,确定主刀医生,并根据病理结果为病例分配急症程度等级。将外科医生分为三组(初级住院医师、高级住院医师和 staff)后比较手术时间。
71例病例纳入研究。三组之间比较平均手术时间时无差异(P = 0.2,方差分析)。每组的病理急症程度相似(P = 0.8,Fisher精确检验)。评估不同病理急症程度的手术时间时有差异(P = 0.002,Kruskal-Wallis检验)。
住院医师水平不影响腹腔镜胆囊切除术的手术时间。三组胆囊的病理急症程度分布相似。基于病理急症程度,平均手术时间存在差异。在教学机构中,腹腔镜胆囊切除术可以安全、高效地进行。