Schachner Thomas, Bonaros Nikolaos, Wiedemann Dominik, Weidinger Felix, Feuchtner Gudrun, Friedrich Guy, Laufer Guenther, Bonatti Johannes
Innsbruck Medical University, Innsbruck, Austria.
Ann Thorac Surg. 2009 Aug;88(2):523-7. doi: 10.1016/j.athoracsur.2009.04.089.
Robotic totally endoscopic coronary bypass (TECAB) surgery was developed during the past decade, and younger surgeons need to be trained in this new modality. This study assessed the learning curves and independent TECAB performance of 2 junior surgeons undergoing TECAB training.
Two surgeons in training performed portions of 44 of 239 robotic TECAB operations, including left (LIMA) and right interior mammary artery (RIMA) harvesting, lipectomy, pericardiotomy, and IMA to left anterior descending coronary artery (LAD) anastomotic suturing.
The procedure portions performed faster by the senior surgeon vs trainees were, in minutes (range), lipectomy, 5 (2 to 18) vs 10 (5 to 21; p < 0.001); pericardiotomy, 5 (1 to 21) vs 7 (3 to 16; p = 0.001); RIMA takedown, 35 (25 to 48) vs 49 (40 to 55; p = 0.034); and LIMA to LAD anastomosis, 26 (12 to 100) vs 34 (24 to 67; p = 0.043). After assuming senior roles in the robotic cardiac surgery program, the 2 trained surgeons performed 14 TECABs (LIMA to LAD) without the senior surgeon. Lipectomy took 5 (3 to 8) minutes; pericardiotomy, 5 (2 to 10) minutes; LIMA takedown, 43 (27 to 70) minutes; LIMA to LAD anastomosis, 24 (15 to 60) minutes, cardiopulmonary bypass time, 73 (40 to 126) minutes; and aortic endo-occlusion time, 53 (0 to 83) minutes. No hospital deaths occurred.
TECAB can be well taught with a stepwise training program involving portions of the procedure performed by trainees. With such an approach, independent performance after training can be within adequate time limits and yields seemingly acceptable results.
机器人全内镜冠状动脉搭桥术（TECAB）在过去十年中得到了发展，年轻外科医生需要接受这种新术式的培训。本研究评估了2名接受TECAB培训的初级外科医生的学习曲线和独立进行TECAB手术的能力。
两名正在接受培训的外科医生参与了239例机器人TECAB手术中的44例手术的部分操作，包括左（LIMA）和右乳内动脉（RIMA）的获取、脂肪切除术、心包切开术以及IMA至左前降支冠状动脉（LAD）的吻合缝合。
与受训医生相比，资深外科医生完成各手术部分的速度更快，以分钟（范围）计，脂肪切除术：5（2至18）对10（5至21；p<0.001）；心包切开术：5（1至21）对7（3至16；p=0.001）；RIMA游离：35（25至48）对49（40至55；p=0.034）；LIMA至LAD吻合：26（12至100）对34（24至67；p=0.043）。在承担机器人心脏手术项目中的资深角色后，这两名经过培训的外科医生在没有资深外科医生在场的情况下进行了14例TECAB（LIMA至LAD）手术。脂肪切除术用时5（3至8）分钟；心包切开术用时5（2至10）分钟；LIMA游离用时43（27至70）分钟；LIMA至LAD吻合用时24（15至60）分钟，体外循环时间73（40至126）分钟；主动脉内阻断时间53（0至83）分钟。无住院死亡病例发生。
通过逐步培训计划，让受训医生参与部分手术操作，可以很好地教授TECAB。采用这种方法，培训后独立进行手术可以在适当的时间限制内完成，并且能取得看似可接受的结果。
