Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI.
Surgery. 2014 Oct;156(4):880-7, 890-3. doi: 10.1016/j.surg.2014.06.020.
Laparoscopic common bile duct exploration (LCBDE) remains an underused treatment for choledocholithiasis, likely in part because of a lack of exposure to the procedure during surgery residency. In this study, we implemented a resident LCBDE curriculum using a previously validated procedural simulator.
Senior surgery residents underwent a curriculum consisting of deliberate practice using the LCBDE simulator. Residents performed a simulated transcystic and transcholedochal LCBDE before and after completing the curriculum, which were rated by three faculty. Passing scores were determined using an Angoff method.
Ten residents participated. For transcystic LCBDE, all 10 residents failed the pretest. Assessment scores improved after the curriculum (20 ± 4 vs 41 ± 2; scale 0-45, P < .01), and all 10 residents passed the posttest. For transcholedochal LCBDE, all 10 residents failed the pretest. Transcholedochal scores improved after the curriculum (27 ± 6 vs 46 ± 4; scale 0-53, P < .01). Eight residents passed the initial posttest and two failed because they sutured the t-tube into the choledochotomy closure. Both underwent remedial training and passed a retest. Resident confidence in performing LCBDE clinically improved for both transcystic and transcholedochal approaches.
This curriculum improved the ability of surgery residents to perform both transcystic and transcholedochal LCBDE on a procedural simulator.
腹腔镜胆总管探查术（LCBDE）仍然是治疗胆总管结石的一种未被充分利用的治疗方法，部分原因可能是在外科住院医师培训期间缺乏对该手术的接触。在这项研究中，我们使用以前经过验证的手术模拟器为住院医师实施了 LCBDE 课程。
高级外科住院医师接受了一项课程，包括使用 LCBDE 模拟器进行刻意练习。住院医师在完成课程前后进行了模拟经胆囊管和经胆总管 LCBDE，由三位教员进行评分。通过 Angoff 方法确定通过分数。
10 名住院医师参加了研究。对于经胆囊管 LCBDE，所有 10 名住院医师都未能通过预测试。课程结束后，评估分数提高（20 ± 4 与 41 ± 2；评分 0-45，P <.01），并且所有 10 名住院医师都通过了后测。对于经胆总管 LCBDE，所有 10 名住院医师都未能通过预测试。经胆总管评分在课程结束后提高（27 ± 6 与 46 ± 4；评分 0-53，P <.01）。8 名住院医师通过了初始后测，有 2 名住院医师因将 T 型管缝合到胆总管切口关闭处而失败。他们都接受了补救性培训并通过了复试。住院医师对经胆囊管和经胆总管 LCBDE 的临床操作信心均有所提高。
该课程提高了外科住院医师在手术模拟器上进行经胆囊管和经胆总管 LCBDE 的能力。
