Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Surg Educ. 2012 Jul-Aug;69(4):468-72. doi: 10.1016/j.jsurg.2012.03.006. Epub 2012 May 5.
Single incision laparoscopic cholecystectomy (SILC) has recently emerged as an option for selected patients undergoing gallbladder removal. While SILC appears safe when performed by experienced surgeons under controlled conditions, there are no studies evaluating the SILC learning curve for incorporation into resident education and the effect on OR efficiency.
DESIGN, SETTING, AND PARTICIPANTS: Chief residents were taught and evaluated by a single attending surgeon facile with SILC techniques. Residents were transitioned from assistants to primary surgeon during their clinical rotation. Outcomes data were prospectively tabulated compared with data from standard laparoscopic SLC and attending surgeon SILC outcomes. The setting was an academic, tertiary care teaching hospital. Participants were chief residents rotating on hepatobiliary surgery service. Residents previously had demonstrated mastery of basic laparoscopic surgical techniques.
Seven chief residents were evaluated with a total of 49 SILCs with a mean of 7 (range 5-12) SILCS/resident. Five conversions to SLC occurred, all within the first 3 SILCs performed by the resident as operative surgeon. Mean blood loss was 30 mL. Median length of stay was <1 day. Average length of operation increased after the first 2 cases, reflecting the transition of the attending surgeon from primary surgeon to assistant role. By the fifth case, operative times returned to the attending surgeon SILC baseline and historical operative times for SLC at our institution. Factors associated with longer-length of surgery were increasing BMI and presence of acute or chronic cholecystitis, choledocholithiasis, and use of intraoperative cholangiogram. Five postoperative complications occurred and were not associated with position along the resident's learning curve. One death occurred due to metastatic laryngeal cancer within 30 days of SILC.
Residents can safely be taught the techniques of SILC with minimal disruption to operating room efficiency. Residents already proficient in the use of standard laparoscopic techniques transition to SILC quickly with a short learning curve and proper instruction.
单孔腹腔镜胆囊切除术（SILC）最近已成为某些患者胆囊切除的一种选择。虽然 SILC 在经验丰富的外科医生在受控条件下进行时似乎是安全的，但目前尚无研究评估 SILC 的学习曲线，以纳入住院医师教育并影响手术室效率。
设计、环境和参与者：主治住院医师由一位熟练掌握 SILC 技术的主治外科医生进行教学和评估。住院医师在其临床轮转期间从助手过渡到主刀医生。前瞻性地对结果数据进行了汇总，并与标准腹腔镜 SILC 和主治外科医生 SILC 结果的数据进行了比较。该环境为学术性三级保健教学医院。参与者为在肝胆外科轮转的主治住院医师。住院医师之前已证明掌握了基本的腹腔镜手术技术。
共有 7 名主治住院医师接受了总共 49 例 SILC 的评估，每位住院医师平均进行 7 例（范围为 5-12 例）SILC。5 例转为 SILC，均发生在住院医师作为手术医生进行的前 3 例 SILC 中。平均失血量为 30 毫升。中位住院时间<1 天。手术时间在最初的 2 例手术后增加，反映了主治外科医生从主刀医生到助手角色的转变。在第 5 例病例中，手术时间恢复到主治外科医生 SILC 的基线和我们机构的 SILC 历史手术时间。与手术时间较长相关的因素包括 BMI 增加以及急性或慢性胆囊炎、胆总管结石和术中胆管造影的存在。发生了 5 例术后并发症，与住院医师学习曲线的位置无关。1 例死亡发生于 SILC 后 30 天，死于转移性喉癌。
可以安全地向住院医师传授 SILC 技术，而对手术室效率的干扰最小。已经熟练掌握标准腹腔镜技术的住院医师在经过适当的指导后，能够快速过渡到 SILC，学习曲线较短。
