Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands. E.Hiemstra @ lumc.nl
Gynecol Obstet Invest. 2011;71(4):268-73. doi: 10.1159/000321796. Epub 2010 Dec 24.
It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents' learning curves of both surgical skills are compared.
Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery.
Nine postgraduate-year-4 residents collected a total of 319 OSATS during the 2 years and 3 months investigation period. These assessments concerned 129 MIS (laparoscopic and hysteroscopic) and 190 conventional (open abdominal and vaginal) procedures. Learning curves (in this study defined as OSATS score plotted against procedure-specific caseload) for MIS and conventional surgery were compared using a linear mixed model. The MIS curve revealed to be steeper than the conventional curve (1.77 vs. 0.75 OSATS points per assessed procedure; 95% CI 1.19-2.35 vs. 0.15-1.35, p < 0.01).
Basic MIS procedures do not seem harder to acquire during residency than conventional surgical procedures. This may have resulted from the incorporation of structured MIS training programs in residency. Hopefully, this will lead to a more successful implementation of the advanced MIS procedures.
人们常说，微创手术（MIS）比传统手术更难掌握。为了验证这一假设，比较了住院医师这两种手术技能的学习曲线。
在妇科手术 3 个月的临床轮转期间，每位住院医师作为主刀医生完成的每台手术都必须使用 OSATS（客观结构化手术评估）的一般总体评分量表进行评估。
在 2 年零 3 个月的研究期间，9 名四年级住院医师共收集了 319 份 OSATS 评估。这些评估涉及 129 例 MIS（腹腔镜和宫腔镜）和 190 例传统（开腹和经阴道）手术。使用线性混合模型比较 MIS 和传统手术的学习曲线（在本研究中定义为 OSATS 评分与特定手术例数的关系）。MIS 曲线比传统曲线陡峭（每例评估手术增加 1.77 分，95%CI 1.19-2.35 分，而 0.15-1.35 分，p < 0.01）。
在住院医师培训期间，基本的 MIS 手术似乎并不比传统手术更难掌握。这可能是由于住院医师培训中纳入了结构化的 MIS 培训计划。希望这将导致更成功地实施高级 MIS 手术。
