将先进的微创手术引入外科实践的可行性。
The feasibility of introducing advanced minimally invasive surgery into surgical practice.
作者信息
Birch Daniel W, Misra Monali, Farrokhyar Forough
机构信息
Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, The Department of Surgery, University of Alberta, Edmonton, Alta, Canada.
出版信息
Can J Surg. 2007 Aug;50(4):256-60.
BACKGROUND
This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment.
METHODS
We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario.
RESULTS
Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively.
CONCLUSION
Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons.
背景
本研究调查了在非专业实践环境中开展高级微创手术（MIS）的可行性。
方法
我们对安大略省目前执业的所有社区普通外科医生进行了横断面调查。
结果
很少有社区外科医生开展大量（每年>10例手术）的高级MIS。大多数（70%）认为掌握高级MIS的额外技能很重要。学习高级MIS最合适的方法被认为是专家指导（79.7%）、课程学习（77.2%）和同事指导（63.9%）。共有57.6%的受访者在执业期间参加过MIS课程，并且大多数人能够使用种类较为合理的器械。受访者认为，57.6%的助手、54.8%的护士和43.4%的麻醉师对高级MIS相对缺乏经验。开展高级MIS的障碍包括手术室使用受限（50%）、资源或设备不足（45.2%）以及专家指导有限（43.6%）。执业年限不足10年的外科医生比执业年限超过10年的外科医生更认为缺乏训练有素的护理人员（7.9%对4.2%，p = 0.01）和经验丰富的助手（12%对6.2%，p = 0.008）是更重要的障碍。
结论
安大略省的大多数普通外科医生在MIS技能方面是自学的，很少有人开展大量的高级MIS。所有受访者中只有一半能够获得熟练的MIS手术室护士、手术助手或麻醉医生的支持。尽管如此，普通外科医生认为引入高级MIS手术的最大障碍是手术室使用受限、资源或设备不足以及指导有限。这项研究表明，许多普通外科医生可能低估了手术团队在高级MIS中的作用。这些数据对于培训普通外科医生以及将更多高级MIS手术纳入普通外科医生的技能范围具有重要意义。
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