Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
J Surg Educ. 2013 Jan-Feb;70(1):144-8. doi: 10.1016/j.jsurg.2012.06.027. Epub 2012 Aug 14.
Laparoscopic surgery for colorectal cancer is safe, but there have been hesitations to implement the technique in all departments. One of the reasons for this may be suboptimal learning possibilities since supervised trainees have not been allowed to do the operations to an adequate extent for the technique to spread. We routinely plan all operations as laparoscopic procedures and most cases are done by supervised trainees. The present study therefore presents the results of operations performed by trainees compared with results obtained by experienced laparoscopic surgeons.
Data for all patients who underwent elective colorectal cancer surgery in 2009 were recorded. Surgeries performed by laparoscopic inexperienced surgeons were compared with the outcome of surgery performed by laparoscopic experienced surgeons. These results were also compared with nationwide data extracted from the national database.
A university teaching department of surgery.
A total of 131 patients underwent colorectal elective surgery in 2009 in the department.
Of the 131 operations, 60% were performed by trainees supervised by experienced laparoscopic colorectal surgeons. The trainees performed a total of 70% of all colonic procedures and 43% of all rectal resections. There were no statistically significant differences between the inexperienced and experienced laparoscopic surgeons with regards to short-term outcome other than increased duration of surgery for colonic resections (198 vs 140 min, p = 0.005). Thus, we found no difference regarding length of stay, conversion to laparotomy, intraoperative bleeding or complications, postoperative complications, or 30-day mortality.
Our data suggest that laparoscopic surgery for colorectal cancer can be performed safely by supervised trainees with good short term results. Therefore, a high volume of operations with an educational potential can easily be maintained when going from open to laparoscopic surgery as the standard operative technique for colorectal cancer in a university department of surgery.
腹腔镜结直肠癌手术安全，但由于监督下的受训者未能充分开展该技术，导致各科室对实施该技术犹豫不决。造成这种情况的原因之一可能是学习机会不理想，因为不允许监督下的受训者充分开展手术，以使该技术得到推广。我们通常将所有手术计划为腹腔镜手术，并且大多数手术都是由监督下的受训者完成。因此，本研究介绍了由受训者进行的手术结果与经验丰富的腹腔镜外科医生的手术结果的比较。
记录了 2009 年所有接受择期结直肠癌手术的患者的数据。比较了腹腔镜经验不足的外科医生进行的手术与腹腔镜经验丰富的外科医生进行的手术的结果。这些结果还与从国家数据库中提取的全国数据进行了比较。
一所大学教学外科系。
该外科系共有 131 例患者在 2009 年接受了结直肠择期手术。
在 131 例手术中，有 60%是由接受经验丰富的腹腔镜结直肠外科医生监督的受训者完成的。受训者总共完成了所有结肠手术的 70%和所有直肠切除术的 43%。除结肠切除术的手术时间延长外（198 分钟比 140 分钟，p = 0.005），经验不足的腹腔镜外科医生和经验丰富的腹腔镜外科医生在短期结果方面没有统计学差异。因此，我们在住院时间、中转开腹、术中出血或并发症、术后并发症或 30 天死亡率方面没有发现差异。
我们的数据表明，由接受监督的受训者进行腹腔镜结直肠癌手术是安全的，并且具有良好的短期效果。因此，当腹腔镜手术成为大学外科系结直肠癌的标准手术技术时，通过从开放手术向腹腔镜手术转变，可以轻松地维持具有教育潜力的高手术量。
