Bailey R W, Imbembo A L, Zucker K A
Department of Surgery, University of Maryland, School of Medicine, Baltimore.
Am Surg. 1991 Apr;57(4):231-6.
A recently developed alternative to traditional laparotomy and cholecystectomy is laparoscopic-guided cholecystectomy. This procedure has the advantages of reduced hospital stay, early return to work, diminished abdominal wall scarring, and less patient discomfort. The complex nature of this procedure and the current lack of extensive clinical experience preclude the traditional "hands-on" training normally practiced in surgical residency programs. At the University of Maryland, we have developed a program to instruct both surgeons and surgical residents in the techniques of laparoscopic surgery. Technical competence is achieved under the close supervision and guidance of an experienced laparoscopic surgeon. Training of residents in this procedure, therefore, is not very different than that for other general surgical procedures. Surgeons already in clinical practice, however, gain experience under somewhat different circumstances. Initial training involves didactic instruction through laparoscopic surgical atlases and educational videotapes. Further training uses a simulation device which enables the trainee to practice techniques of laparoscopic suturing, knot-tying, and clip application. Actual operative experience is acquired primarily in experimental animal preparations. Laparoscopic-guided removal of the gallbladder is performed in young swine (20-25 kg) under conditions that mimic those in the operating room. Further clinical experience can be acquired by assisting on several laparoscopic operations, usually involving diagnostic or pelvic procedures. Actual operative experience with laparoscopic cholecystectomy, of course, comprises the final phase of the educational program. The introduction of clinical laparoscopic training into general surgery residency programs should influence the widespread adoption of this new procedure.
最近开发的一种替代传统剖腹术和胆囊切除术的方法是腹腔镜引导下胆囊切除术。该手术具有住院时间缩短、能早日重返工作岗位、腹壁瘢痕减少以及患者不适感减轻等优点。由于该手术的复杂性以及目前缺乏广泛的临床经验，传统外科住院医师培训项目中通常采用的“亲身实践”培训方式并不适用。在马里兰大学，我们开发了一个项目，用于指导外科医生和外科住院医师掌握腹腔镜手术技术。在经验丰富的腹腔镜外科医生的密切监督和指导下，实现技术能力的提升。因此，对住院医师进行该手术的培训与其他普通外科手术的培训并没有太大差异。然而，已经在临床实践中的外科医生是在 somewhat different circumstances下积累经验的。初始培训包括通过腹腔镜手术图谱和教学录像带进行理论指导。进一步的培训使用一种模拟设备，使受训者能够练习腹腔镜缝合、打结和夹闭应用等技术。实际手术经验主要在实验动物准备过程中获得。在模拟手术室的条件下，对幼猪（20 - 25千克）进行腹腔镜引导下的胆囊切除。通过协助进行几次腹腔镜手术，通常是诊断性或盆腔手术，可以获得更多临床经验。当然，腹腔镜胆囊切除术的实际手术经验是教育项目的最后阶段。将临床腹腔镜培训引入普通外科住院医师培训项目应该会影响这种新手术的广泛采用。 （注：原文中“somewhat different circumstances”未明确具体意思，直接保留英文）
