Wood Stephanie G, Dai Feng, Dabu-Bondoc Susan, Mikhael Hosni, Vadivelu Nalini, Duffy Andrew, Roberts Kurt E
Department of Surgery, Yale School of Medicine, 40 Temple St., Suite 7B, New Haven, CT, 06510, USA,
Surg Endosc. 2015 Jul;29(7):1837-41. doi: 10.1007/s00464-014-3873-3. Epub 2014 Oct 8.
There are few surgeons in the United States, within private practice and academic centers, currently performing transvaginal cholecystectomies (TVC). The lack of exposure to TVC during residency or fellowship training, coupled with a poorly defined learning curve, further limits interested surgeons who want to apply this technique to their practice. This study describes the learning curve encountered during the introduction of TVC to our academic facility.
This study is an analysis of consecutive TVCs performed between August 14, 2009 and August 3, 2012 at an academic center. The TVC patients were divided into sequential quartiles (n = 15/16). The learning curve outcome was measured as the operative time of TVC patients and compared to the operative time of female laparoscopic cholecystectomy (LC) patients performed during the same time period.
Sixty-one patients underwent a TVC with a mean age of 38 ± 12 years and mean BMI was 29 ± 6 kg/m(2). Sixty-seven female patients who underwent a LC with average age 41 ± 15 years and average BMI 33 ± 12 kg/m(2). The average operative time of LC patients and TVC patients was 48 ± 20 and 60 ± 17 min, respectively. Significant improvement in TVC operative times was seen between the first (n = 15 TVCs) and second quartiles (p = 0.04) and stayed relatively constant for third quartile, during which there was no statistically significant difference between the mean LC operative time for the second and third TVC quartiles
The learning curve of a fellowship-trained surgeon introducing TVC to their surgical repertoire, as measured by improved operative times, can be achieved with approximately 15 cases.
在美国，无论是私人诊所还是学术中心，目前进行经阴道胆囊切除术（TVC）的外科医生都很少。住院医师或专科培训期间缺乏TVC相关接触，再加上学习曲线尚不明确，这进一步限制了那些想将该技术应用于临床实践的有兴趣的外科医生。本研究描述了在我们学术机构引入TVC过程中所遇到的学习曲线。
本研究分析了2009年8月14日至2012年8月3日在一个学术中心连续进行的TVC手术。将TVC患者分为连续的四分位数组（n = 15/16）。学习曲线结果以TVC患者的手术时间来衡量，并与同期进行的女性腹腔镜胆囊切除术（LC）患者的手术时间进行比较。
61例患者接受了TVC手术，平均年龄为38 ± 12岁，平均体重指数为29 ± 6 kg/m²。67例女性患者接受了LC手术，平均年龄41 ± 15岁，平均体重指数33 ± 12 kg/m²。LC患者和TVC患者的平均手术时间分别为48 ± 20分钟和60 ± 17分钟。TVC手术时间在第一组（n = 15例TVC）和第二四分位数组之间有显著改善（p = 0.04），第三四分位数组相对稳定，在此期间，第二和第三TVC四分位数组的平均LC手术时间之间无统计学显著差异。
通过大约15例手术，以手术时间改善来衡量，接受过专科培训的外科医生将TVC纳入其手术技能范围的学习曲线是可以实现的。
