Kim Young Wan, Min Byung Soh, Kim Nam Kyu, Kim Jeong Yeon, Hur Hyuk, Lee Kang Young, Sohn Seung Kook, Cho Chang Hwan
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):36-41. doi: 10.1097/SLE.0b013e3181cdb762.
To evaluate whether the incorporation of a novice first assistant into a laparoscopic team affects operative outcomes after laparoscopic sigmoidectomy for sigmoid colon cancer.
Sixty-five patients who underwent laparoscopic sigmoidectomy were prospectively enrolled in this study between March 2008 and October 2008. One surgeon with a novice first assistant during the study period carried out all operations. Outcomes of this population were compared with those of 50 patients (control group) that underwent laparoscopic sigmoidectomy between March 2007 and February 2008 by the same surgeon with an experienced first assistant. The 65 patients operated upon with the involvement of the novice (the patients group) were allocated to 2 groups by case number, that is, to an early group (case numbers 1 to 10) and to a late group (case numbers 11 to 65).
Mean operative times were 233+/-50 minutes in the control group, 305+/-113 minutes in the early group, and 226+/-58 minutes in the late group (P=0.04). Multiple regression analysis showed that in the early group, body mass index and tumor diameter significantly contributed to operative time. The incidences of intraoperative and postoperative complications were not significantly different in the early, late, and control groups.
The incorporation of a novice first assistant into a laparoscopic team was not found to affect operative outcomes adversely. However, in terms of operative time, novice assistants probably need experience of around 10 cases before they can be viewed as fully competent surgical team members during laparoscopic sigmoidectomy.
评估在腹腔镜乙状结肠癌切除术的腹腔镜团队中纳入新手第一助手是否会影响手术结果。
2008年3月至2008年10月期间，前瞻性纳入65例行腹腔镜乙状结肠切除术的患者。在研究期间，由一名配备新手第一助手的外科医生实施所有手术。将该组患者的结果与2007年3月至2008年2月期间由同一名外科医生配备经验丰富的第一助手进行腹腔镜乙状结肠切除术的50例患者（对照组）的结果进行比较。65例有新手参与手术的患者（患者组）按病例号分为2组，即早期组（病例号1至10）和晚期组（病例号11至65）。
对照组平均手术时间为233±50分钟，早期组为305±113分钟，晚期组为226±58分钟（P = 0.04）。多元回归分析显示，在早期组中，体重指数和肿瘤直径对手术时间有显著影响。早期、晚期和对照组术中及术后并发症的发生率无显著差异。
未发现将新手第一助手纳入腹腔镜团队会对手术结果产生不利影响。然而，就手术时间而言，新手助手可能需要大约10例手术的经验，才能在腹腔镜乙状结肠切除术期间被视为完全胜任的手术团队成员。
