Welty G, Schippers E, Grablowitz V, Lawong A G, Tittel A, Schumpelick V
Department of Surgery, University Hospital RWTH Aachen, Pauwelslrasse 30, D-52072 Aachen, Germany.
Surg Endosc. 2002 May;16(5):820-7. doi: 10.1007/s00464-001-9019-4. Epub 2002 Feb 8.
More than 10 years after its introduction, laparoscopic cholecystectomy has become the method of choice for the treatment of cholecystolithiasis. However intraoperative difficulties with dramatic postoperative consequences have been reported. The aim of this study was to identify what role the two-dimensional view, the surgeon's experience, the instruments, technical tools and their (time) influence exercised on the operation course in daily laparoscopic operations.
The operative times for 30 laparoscopic cholecystectomies were investigated by ergonomic sequence analysis and analyzed statistically with the use of the Wilcoxon test.
Comparing experienced and less experienced surgeons, a significant difference in the duration of the operation was observed (56 +/- 24 min compared to 75 +/- 13 min p = 0,025), especially in the laparoscopic intra-abdominal phase of the operation. The prolonged duration of the operation (15-20%) was mainly due to problems with the technical tools (40%) and the use of instruments (23.5%). Visualization had a minor influence (14.4%) on the duration of the operation, and the negative effect of the two-dimensional view (0.5%) was negligible. The last two factors did not cause any complications.
The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon's experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon's demands for a safe procedure.
腹腔镜胆囊切除术应用超过10年后，已成为治疗胆囊结石的首选方法。然而，有报道称术中存在困难并伴有严重的术后后果。本研究的目的是确定二维视野、外科医生的经验、器械、技术工具及其（时间）影响在日常腹腔镜手术的手术过程中所起的作用。
通过人体工程学顺序分析研究30例腹腔镜胆囊切除术的手术时间，并使用Wilcoxon检验进行统计学分析。
比较经验丰富和经验较少的外科医生，观察到手术持续时间存在显著差异（分别为56±24分钟和75±13分钟，p = 0.025），尤其是在腹腔镜腹腔内手术阶段。手术时间延长（15 - 20%）主要归因于技术工具问题（40%）和器械使用（23.5%）。可视化对手术持续时间影响较小（14.4%），二维视野的负面影响（0.5%）可忽略不计。后两个因素未导致任何并发症。
已认识到的困难仍然会导致时间损失，在某些情况下还会引发并发症，而外科医生的经验只能部分弥补这些问题。这导致在疾病更复杂阶段应用腹腔镜胆囊切除术时有所顾虑。二维视野满足了外科医生对安全手术过程的要求。
