Department of Surgery, Hospital of Saint Raphael, New Haven, Connecticut 06511, USA.
J Surg Educ. 2010 Sep-Oct;67(5):316-9. doi: 10.1016/j.jsurg.2010.08.001.
The purpose of this study was to evaluate the impact of laparoscopy on the volume of open cases in general surgery residency training over the past 10 years.
The Accreditation Council for Graduate Medical Education (ACGME) database (1999-2008), which records all cases (by Current Procedural Terminology code) performed by graduating general surgery trainees, was retrospectively analyzed.
ACGME database (1999-2008).
Trends were compared regarding the average number of the most common laparoscopic and open procedures (colectomy, hernia, and appendectomy) performed by graduating general surgery trainees during the reporting period.
Across all procedures, an increase was noted in laparoscopic approaches with a reciprocal decrease in open cases. The number of open appendectomies decreased by 29% (30.7 to 21.7), whereas the number of laparoscopic appendectomies increased by 278% (8.5 to 32.1). Similarly, open inguinal hernia cases decreased by 12.5% (51.9 to 45.4) and open colectomy cases decreased by 10.4% (48 to 43). Conversely, laparoscopic hernia repair and laparoscopic colectomy increased by 87.5% (7.6 to 15.8) and 550% (2 to 13), respectively.
In addition to the limitations placed on residency training by other factors (including work hour restrictions), changing practice patterns within the field of general surgery have a significant impact on the exposure of residents to open surgery cases. This trend might have far-reaching implications with regard to the overall competency of graduating residents and raises concerns for the future direction of surgical education.
本研究旨在评估过去 10 年来腹腔镜技术对普通外科住院医师培训中开放手术数量的影响。
回顾性分析美国毕业后医学教育认证委员会（ACGME）数据库（1999-2008 年）中记录的所有由即将毕业的普通外科住院医师完成的手术（按当前操作术语代码分类）。
ACGME 数据库（1999-2008 年）。
比较报告期内普通外科住院医师实施的最常见腹腔镜和开放手术（结肠切除术、疝修补术和阑尾切除术）的平均数量趋势。
所有手术中，腹腔镜手术的比例增加，开放手术的比例相应减少。开放阑尾切除术的数量减少了 29%（30.7 例至 21.7 例），而腹腔镜阑尾切除术的数量增加了 278%（8.5 例至 32.1 例）。同样，开放腹股沟疝病例减少了 12.5%（51.9 例至 45.4 例），开放结肠切除术病例减少了 10.4%（48 例至 43 例）。相反，腹腔镜疝修补术和腹腔镜结肠切除术分别增加了 87.5%（7.6 例至 15.8 例）和 550%（2 例至 13 例）。
除了其他因素（包括工作时间限制）对住院医师培训的限制外，普通外科领域实践模式的变化对住院医师接受开放手术病例的情况有重大影响。这种趋势可能对毕业住院医师的整体能力产生深远影响，并引发对未来外科教育方向的关注。
