Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
J Endourol. 2011 Jun;25(6):1063-7. doi: 10.1089/end.2010.0304. Epub 2011 Apr 10.
The application of minimally invasive surgery (MIS) has become increasingly common in urology training programs and clinical practice. Our objective was to review surgical case data from all 12 Canadian residency programs to identify trends in resident exposure to MIS and open procedures.
Every year, beginning in 2003, an average of 41 postgraduate year 3 to 5 residents reported surgical case data to a secure internet relational database. Data were anonymized and extracted for the period 2003 to 2009 by measuring a set of 11 predefined index cases that could be performed in both an open and MIS fashion.
16,687 index cases were recorded by a total of 198 residents. As a proportion, there was a significant increase in MIS from 12% in 2003 to 2004 to 32% in 2008 to 2009 (P=0.01). A significant decrease in the proportion of index cases performed with an open approach was also observed from 88% in 2003 to 2004 to 68% in 2008 to 2009 (P=0.01). The majority of these shifts were secondary to the increased application of MIS for nephrectomies of all type (29%-45%), nephroureterectomy (27%-76%), adrenalectomy (15%-71%), and pyeloplasty (17%-54%) (P<0.0001 for all). While there was a significant increase in MIS experience with radical prostatectomy (2%-18%, P<0.0001), the majority of these were still taught in an open fashion during the study period.
MIS constitutes an increasingly significant component of surgical volume in Canadian urology residencies with a reciprocal decrease in exposure to open surgery. These trends necessitate ongoing evaluation to maintain the integrity of postgraduate urologic training.
微创外科（MIS）的应用在泌尿科培训计划和临床实践中变得越来越普遍。我们的目的是审查来自加拿大所有 12 个住院医师培训计划的手术病例数据，以确定住院医师接受 MIS 和开放手术的趋势。
自 2003 年开始，每年平均有 41 名住院医师 3 至 5 年级报告手术病例数据到一个安全的互联网关系数据库。通过测量一组 11 个预先定义的索引病例，可以以开放和 MIS 两种方式进行，数据被匿名提取并用于 2003 年至 2009 年的时间段。
198 名住院医师共记录了 16687 个索引病例。作为一个比例，MIS 的比例从 2003 年至 2004 年的 12%显著增加到 2008 年至 2009 年的 32%（P=0.01）。开放手术的比例也从 2003 年至 2004 年的 88%显著下降到 2008 年至 2009 年的 68%（P=0.01）。这些变化的大部分是由于所有类型的肾切除术（29%-45%）、肾输尿管切除术（27%-76%）、肾上腺切除术（15%-71%）和肾盂成形术（17%-54%）的 MIS 应用增加（所有手术均 P<0.0001）。虽然根治性前列腺切除术的 MIS 经验显著增加（2%-18%，P<0.0001），但在研究期间，这些手术大部分仍以开放方式进行。
MIS 构成加拿大泌尿科住院医师培训中手术量的一个越来越重要的组成部分，同时开放手术的暴露量相应减少。这些趋势需要持续评估，以保持泌尿科住院医师培训的完整性。
