Heniford B T, Matthews B D, Box E A, Backus C L, Kercher K W, Greene F L, Sing R F
Department of General Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
Hernia. 2002 Mar;6(1):17-20. doi: 10.1007/s10029-002-0045-5.
The introduction of laparoscopic techniques after residency training has created a new paradigm dependent on laparoscopic workshops. This study tested the benefit of an animate course and evaluated the role of proctoring in learning to perform laparoscopic ventral hernia repair (LVHR). Surgeons who had taken a 1-day LVHR course (n = 59) were polled to determine previous experience with laparoscopic procedures and experience with LVHR after the course. Forty-eight (81%) surgeons completing the course responded. Thirty-two (67%) surgeons had performed 179 LVHRS (mean 5.6) since the course. There were no statistically significant differences between the groups performing and not performing LVHR regarding academic/private practice (P=0.8) or opportunities to perform a ventral herniorrhaphy (P = 0.6). Fifteen (31%) surgeons were precepted in their hospital operating room by the lead author. Thirteen (87%) of precepted surgeons had performed a LVHR compared with 19 (58%) of the 33 surgeons taking the course without a precepted intervention (P = 0.05). Surgeons with experience performing laparoscopic inguinal hernia repair, Nissen fundoplication, and common bile duct exploration were more likely to perform LVHR (P=0.0001). Surgeons performing only laparoscopic cholecystectomy tended to be less likely to perform LVHR, nearing statistical significance (P=0.08). Surgeons with prior advanced laparoscopic surgery experience are thus more likely to perform LVHR after participating in a 1-day course. Surgeons precepted in their hospital operating room were also more likely to perform LVHR. Participation in an animate laboratory and a precepted experience can impact the future performance of advanced laparoscopic surgery.
住院医师培训后腹腔镜技术的引入创造了一种依赖腹腔镜研习班的新模式。本研究测试了一个动态课程的益处，并评估了带教在学习进行腹腔镜腹疝修补术（LVHR）中的作用。对参加过为期1天LVHR课程的外科医生（n = 59）进行了调查，以确定他们以前的腹腔镜手术经验以及课程结束后LVHR的经验。48名（81%）完成课程的外科医生进行了回复。自课程结束以来，32名（67%）外科医生进行了179例LVHR手术（平均5.6例）。在进行和未进行LVHR的两组外科医生之间，在学术/私人执业方面（P = 0.8）或进行腹疝修补术的机会方面（P = 0.6）没有统计学上的显著差异。15名（31%）外科医生在其医院手术室由第一作者进行带教。接受带教的外科医生中有13名（87%）进行了LVHR手术，而在未接受带教干预的33名参加课程的外科医生中有19名（58%）进行了LVHR手术（P = 0.05）。有腹腔镜腹股沟疝修补术、nissen胃底折叠术和胆总管探查术经验的外科医生更有可能进行LVHR手术（P = 0.0001）。仅进行腹腔镜胆囊切除术的外科医生进行LVHR手术的可能性往往较小，接近统计学意义（P = 0.08）。因此，有先前高级腹腔镜手术经验的外科医生在参加为期1天的课程后更有可能进行LVHR手术。在其医院手术室接受带教的外科医生也更有可能进行LVHR手术。参与动态实验室和带教经验会影响未来高级腹腔镜手术的开展。
