Jain P K, Hayden J D, Sedman P C, Royston C M S, O'Boyle C J
Division of Upper Gastrointestinal and Minimally Invasive Surgery, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom.
Surg Endosc. 2005 Aug;19(8):1082-5. doi: 10.1007/s00464-004-2170-y. Epub 2005 May 26.
Even though ambulatory laparoscopic cholecystectomy (ALC) is safe and cost effective, this approach has yet to gain acceptance in the United Kingdom. We report our 5-year experience of ALC with emphasis on its appropriateness for higher surgical training.
Between July 1997 and July 2002, patients with symptomatic cholelithiasis who met with appropriate criteria underwent ALC. Surgery was performed either by a consultant surgeon or a higher surgical trainee (HST) under direct supervision in our dedicated day surgery unit. Data were recorded prospectively and patients were interviewed postoperatively by an independent researcher.
There were 269 patients (231 female and 38 male) with a median age of 46 years (range 17-76). Conversion to open cholecystectomy was necessary in three cases (1%). Of the patients, 79% (213) were discharged within 8 hours of surgery; 95% (256) were discharged on the same day. Thirteen patients (5%) required overnight admission as inpatients. An HST performed 166 (62%) of the procedures. There was a statistically significant difference in operating time between consultants (41 min) and trainees (47 min, P = 0.001) but no significant difference in clinical outcome or patient satisfaction. The mean procedural cost to the hospital was 768 pound sterling for ALC compared with 1430 pound sterling for an inpatient operation. Of patients, 87% expressed satisfaction with the day case operation.
Our results for ALC compare favorably with published series. In addition, we have demonstrated that the operation can be performed safely by HST under direct supervision without compromising operating lists or safety.
尽管非住院腹腔镜胆囊切除术（ALC）安全且具有成本效益，但这种方法在英国尚未得到广泛认可。我们报告了我们5年的ALC经验，重点强调其在高级外科培训中的适用性。
在1997年7月至2002年7月期间，符合适当标准的有症状胆结石患者接受了ALC。手术由顾问外科医生或高级外科实习生（HST）在我们专门的日间手术单元直接监督下进行。数据进行前瞻性记录，术后由独立研究人员对患者进行访谈。
共有269例患者（231例女性和38例男性），中位年龄为46岁（范围17 - 76岁）。3例（1%）患者需要转为开腹胆囊切除术。其中79%（即213例）的患者在手术后8小时内出院；95%（256例）在同一天出院。13例患者（5%）需要住院过夜。166例（62%）手术由HST完成。顾问医生的手术时间（41分钟）与实习生的手术时间（47分钟，P = 0.001）在统计学上有显著差异，但临床结果或患者满意度无显著差异。医院进行ALC的平均手术成本为768英镑，而住院手术为1430英镑。87%的患者对日间手术表示满意。
我们的ALC结果与已发表的系列研究相比具有优势。此外，我们证明了在直接监督下，HST可以安全地进行该手术，而不会影响手术安排或安全性。
