Ibrahim Salleh, Tay Khoon Hean, Lim Swee Ho, Ravintharan T, Tan Ngian Chye
Department of General Surgery, Changi General Hospital, Singapore.
Langenbecks Arch Surg. 2008 Nov;393(6):943-8. doi: 10.1007/s00423-007-0269-z. Epub 2008 Jan 10.
Laparoscopic cholecystectomy is an established treatment for almost all gallbladder diseases with bile duct injury rates similar to open cholecystectomy. These laparoscopic skills must be passed on to junior surgeons without compromising patient safety.
We analysed our structured training programme over 6years (May 2000 to May 2006) by following three trainee surgeons during their training and beyond. During this period, 1,000 laparoscopic cholecystectomies were carried out with five consultant surgeons supervising and three new trainees who completed their accreditation in laparoscopic cholecystectomy.
There were 694 patients operated on by consultant surgeons (Group 1), 202 by trainee surgeons (Group 2) and 104 by newly trained surgeons (Group 3). There were no differences between the groups in terms of age and gender. However, there was a significant difference in gallbladder disease among the three groups; Group 2 had more gallstone pancreatitis patients (P < 0.019). There were no differences among the three groups in conversion rates, bile duct injury rates, general complication rates or length of stay. However, the duration of operation in Group 2 was significantly longer compared to the other two groups (P < 0.0001).
This programme is effective in training junior surgeons and does not compromise patient safety.
腹腔镜胆囊切除术是几乎所有胆囊疾病的既定治疗方法，其胆管损伤率与开腹胆囊切除术相似。必须将这些腹腔镜技术传授给初级外科医生，同时又不影响患者安全。
我们通过跟踪三名实习外科医生在培训期间及之后的情况，分析了我们在6年（2000年5月至2006年5月）期间的结构化培训计划。在此期间，在五名顾问外科医生的监督下进行了1000例腹腔镜胆囊切除术，三名新学员完成了腹腔镜胆囊切除术的认证。
顾问外科医生为694例患者进行了手术（第1组），实习外科医生为202例（第2组），新培训的外科医生为104例（第3组）。三组在年龄和性别方面没有差异。然而，三组之间胆囊疾病存在显著差异；第2组胆石性胰腺炎患者更多（P<0.019）。三组在中转率、胆管损伤率、一般并发症发生率或住院时间方面没有差异。然而，第2组的手术时间明显长于其他两组（P<0.0001）。
该计划在培训初级外科医生方面有效，且不影响患者安全。
