Romero Rey Jesús, Arad Jonathan Kirsch, Kosanovic Radomir, Lamoureux Julie, Gonzalez Anthony Michael
JSLS. 2014 Jan-Mar;18(1):8-13. doi: 10.4293/108680813x13693422520765.
Minimally invasive surgery fellowship programs have been created in response to advancements in technology and patient's demands. Single-incision laparoscopic cholecystectomy (SILC) is a technique that has been shown to be safe and feasible, but this appears to be the case only for experienced surgeons. The purpose of this study is to evaluate the impact of minimally invasive surgery fellow participation during SILC.
We reviewed data from our experience with SILC during 3 years. The cases were divided in two groups: group 1 comprised procedures performed by the main attending without the presence of the fellow, and group 2 comprised procedures performed with the fellow present during the operation. Demographic characteristics, comorbidities, indication for surgery, total surgical time, hospital length of stay, and complications were evaluated.
The cohort included 229 patients: 142 (62%) were included in group 1 and 87 (38%) in group 2. No differences were found in demographic characteristics, comorbidities, and indication for surgery between groups. The total surgical time was 34.4 ± 11.4 minutes for group 1 and 46.8 ± 16.0 minutes for group 2 (P < .001). The hospital length of stay was 0.89 0.32 days for group 1 and 1.01 ± 0.40 days for group 2 (P = .027). No intraoperative complications were seen in either group. There were 3 postoperative complications (2.1%) in group 1 and none in group 2 (P = .172).
Adoption of SILC during an established fellowship program is safe and feasible. A longer surgical time is expected during the teaching process.
随着技术进步和患者需求的变化，微创外科进修项目应运而生。单孔腹腔镜胆囊切除术（SILC）是一项已被证明安全可行的技术，但这似乎仅适用于经验丰富的外科医生。本研究旨在评估微创外科进修医生参与单孔腹腔镜胆囊切除术的影响。
我们回顾了3年期间单孔腹腔镜胆囊切除术的经验数据。病例分为两组：第1组为主要主治医生在无进修医生在场的情况下进行的手术，第2组为手术过程中有进修医生在场的手术。评估了人口统计学特征、合并症、手术指征、总手术时间、住院时间和并发症情况。
该队列包括229例患者：第1组142例（62%），第2组87例（38%）。两组在人口统计学特征、合并症和手术指征方面未发现差异。第1组的总手术时间为34.4±11.4分钟，第2组为46.8±16.0分钟（P<.001）。第1组的住院时间为0.89±0.32天，第2组为1.01±0.40天（P=.027）。两组均未出现术中并发症。第1组有3例术后并发症（2.1%），第2组无（P=.172）。
在既定的进修项目中采用单孔腹腔镜胆囊切除术是安全可行的。教学过程中预计手术时间会更长。
