Jones A, Eden C, Sullivan M E
Royal Berkshire Hospital, London, Reading, UK.
Ann R Coll Surg Engl. 2007 May;89(4):422-5. doi: 10.1308/003588407X183292.
The objective of this study is to report a novel system of 'mutual mentoring' that overcomes the limited availability of laparoscopic mentors and allows progression from laboratory and fellowship experience into independent clinical practice.
A total of 88 laparoscopic cases were performed during the fellowship. In the first 2 years as consultants, we (AJ and MS) performed 151 cases with mutual mentoring (simple nephrectomy [n = 28], radical nephrectomy [n = 35], nephro-ureterectomy [n = 19], pyeloplasty [n = 31], pelvic LND [n = 21], others [n = 17]).
Mutual mentoring has resulted in the successful introduction of laparoscopic services to two hospitals, allowing an exposure to an average of two cases a week. Complication rates are acceptable and objective measures such as conversion rates, operative time and blood loss appear to be improving.
Mutual mentoring allows for a greater through-put of cases, a high level of assistance, advice with intra-operative decisions and the potential to 'share' cases, reducing fatigue and increasing experience. It provides significant moral support in the difficult early days of starting the service. Its disadvantages are that it is time consuming and is geographically restrictive. Mutual mentoring has allowed us to introduce a laparoscopic service at our respective hospitals with high case-load acceptable complication rates.
本研究的目的是报告一种新型的“相互指导”系统，该系统克服了腹腔镜手术指导人员数量有限的问题，并使从实验室和进修经验过渡到独立临床实践成为可能。
在进修期间共进行了88例腹腔镜手术。在担任顾问的头两年，我们（AJ和MS）通过相互指导进行了151例手术（单纯肾切除术[n = 28]、根治性肾切除术[n = 35]、肾输尿管切除术[n = 19]、肾盂成形术[n = 31]、盆腔淋巴结清扫术[n = 21]、其他手术[n = 17]）。
相互指导已成功地将腹腔镜手术服务引入两家医院，平均每周可接触两例病例。并发症发生率在可接受范围内，诸如中转率、手术时间和失血量等客观指标似乎也在改善。
相互指导可实现更高的手术量、高水平的协助、术中决策建议以及“共享”病例的可能性，减少疲劳并增加经验。在开展该服务的困难初期，它提供了重要的精神支持。其缺点是耗时且受地域限制。相互指导使我们能够在各自医院引入腹腔镜手术服务，手术量高且并发症发生率可接受。
