IRCAD-EITS Institute, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
Int J Colorectal Dis. 2012 Jan;27(1):65-9. doi: 10.1007/s00384-011-1290-9. Epub 2011 Aug 23.
The aim of this study is to evaluate the impact of an expert monitoring on the quality and results of laparoscopic reversal of Hartmann's procedure (LRHP) performed by trainee surgeons by comparing their results to the expert's outcomes.
Forty-two LRHP were performed between 2000 and 2008 following a step-by-step, standardised, full laparoscopic procedure. Patients operated upon by a senior surgeon were compared to patients operated upon by trainee surgeons while being mentored by the senior surgeon. Operative time, conversion, complications and post-operative outcome were measured.
Each group included 21 patients. All patients underwent LRHP successfully. Two procedures were converted. No significant difference was observed between the expert and the trainees: operative time, 132 min (SD ± 50) vs. 131 min (SD ± 47) and complications (2-14%), 4 vs. 2. Three complications required re-operation, and three other were treated medically, including one dilatation of an anastomosis. Post-operative outcomes were comparable (oral intake, 3 vs. 2 days; post-operative hospital stay, 6 vs. 7.5 days); no mortality occurred.
Standardisation simplifies this difficult laparoscopic procedure and offers the same outcome whether it is performed by an expert or by mentored trainees. The complications were comparable to those occurring at experienced centres (anastomotic leak or stricture, ureteral injury, re-operation). The expert mentoring does not prevent all complications but can solve intra-operative technical problems, thus improving the trainee's confidence. Mentoring should be promoted as it can be performed locally or remotely using modern interactive technology.
本研究旨在通过比较受训者外科医生的结果与专家的结果，评估专家监测对受训者外科医生行腹腔镜下 Hartmann 手术逆行（LRHP）的质量和结果的影响。
2000 年至 2008 年间，采用分步式、标准化、全腹腔镜手术方法进行了 42 例 LRHP。将由高级外科医生操作的患者与在高级外科医生指导下接受培训的外科医生操作的患者进行比较。测量手术时间、转化率、并发症和术后结果。
每组包括 21 例患者。所有患者均成功接受 LRHP。有两例手术转为开腹手术。专家与受训者之间未观察到显著差异：手术时间分别为 132 分钟（SD±50）和 131 分钟（SD±47）；并发症（2-14%）分别为 4 例和 2 例。3 例并发症需要再次手术，另外 3 例接受药物治疗，包括 1 例吻合口扩张。术后结果相似（口服摄入分别为 3 天和 2 天；术后住院时间分别为 6 天和 7.5 天）；无死亡发生。
标准化简化了这一困难的腹腔镜手术，无论由专家还是经过指导的受训者进行，都能获得相同的结果。并发症与经验丰富的中心（吻合口漏或狭窄、输尿管损伤、再次手术）相似。专家指导并不能预防所有并发症，但可以解决术中技术问题，从而提高受训者的信心。应提倡指导，因为它可以使用现代互动技术在本地或远程进行。
