Department of Neurosurgery, Rennes University Hospital, INSERM, U746, Faculty of Medicine, INRIA, VisAGeS Unit/Project, CNRS, UMR 6074, IRISA, University of Rennes I, Rennes, France.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):325-32. doi: 10.1227/NEU.0b013e3181f741d7.
Evaluating surgical practice in the operating room is difficult, and its assessment is largely subjective.
Recording of standardized spine surgery processes was conducted to ascertain whether any significant differences in surgical practice could be observed between senior and junior neurosurgeons.
Twenty-four procedures of lumbar discectomies were consecutively recorded by a senior neurosurgeon. In 12 cases, surgery was entirely performed by a senior neurosurgeon with the aid of a resident, and in the 12 remaining cases, surgery was performed by a resident with the aid of a senior neurosurgeon. The data recorded were general parameters (operating time for the whole procedure and for each step), and general and specific parameters of the surgeon's activities (number of manual gestures, number and duration of actions performed, use of the instruments, and use of interventions on anatomic structures). The Mann-Whitney U test was used for comparison between the 2 groups of neurosurgeons.
The operating time was statistically lower for the group of senior surgeons. The seniors statistically demonstrated greater economy in time and in gestures during the closure step, for sewing and for the use of scissors, needle holders, and forceps. The senior surgeons statistically worked for a shorter time on the skin and used fewer manual gestures on the thoracolumbalis fascia. The number of changes in microscope position was also statistically lower for this group.
There is a relationship between surgical practice, as determined by a method of objective measurement using observation software, and surgical experience: gesture economy evolves with seniority.
评估手术室中的手术操作具有挑战性，其评估在很大程度上是主观的。
记录标准化的脊柱手术过程，以确定资深和初级神经外科医生之间的手术实践是否存在任何显著差异。
由一名资深神经外科医生连续记录 24 例腰椎间盘切除术。在 12 例中，手术完全由资深神经外科医生协助住院医生完成，而在其余 12 例中，手术由住院医生协助资深神经外科医生完成。记录的数据包括一般参数（整个手术过程和每个步骤的手术时间）以及外科医生活动的一般和具体参数（手动动作的数量、执行的动作数量和持续时间、器械的使用以及对解剖结构的干预）。使用 Mann-Whitney U 检验对 2 组神经外科医生进行比较。
资深外科医生组的手术时间在统计学上较低。在关闭步骤、缝合以及使用剪刀、持针器和镊子时，资深外科医生在时间和动作上表现出更高的经济性。资深外科医生在皮肤操作上的时间更短，在使用胸腰筋膜上的手动动作更少。该组的显微镜位置改变次数也在统计学上较低。
使用观察软件进行客观测量的方法确定的手术实践与手术经验之间存在关系：随着经验的积累，动作的经济性会提高。
