Celentano Valerio, Finch David, Forster Luke, Robinson Jonathan M, Griffith John P
Colorectal Unit, Bradford Royal Infirmary, Bradford, UK,
Int J Colorectal Dis. 2015 May;30(5):639-44. doi: 10.1007/s00384-015-2147-4. Epub 2015 Feb 12.
There is a significant risk of surgical resection during the lifetime of an inflammatory bowel disease (IBD) patient: laparoscopic surgery has been increasingly applied to the management of IBD with short and long-term advantages. The aim of this study is to demonstrate that laparoscopic surgery for IBD, performed by a surgical trainee under the supervision of an experienced trainer, is feasible and safe.
All surgical procedures were sub-divided in six critical steps in order to define the procedure as supervised trainee performed (STP) when the trainer was present unscrubbed in the theatre or assisting and trainer performed (TNER) when the trainer performed two or more critical steps of the procedure. Included were all patients undergoing laparoscopic resection for IBD between January 2009 and December 2013. Thirty-day mortality and morbidity were the primary outcomes. Reoperations and rehospitalizations within 30 days of discharge were recorded prospectively and were the secondary outcomes together with conversion rate and length of hospital stay.
One hundred fifty-one patients were included: 77 (50.99%) STP and 74 (49.01%) TNER. No deaths occurred, and 30-day morbidity was 27.15% with no differences between the groups. Operating time was longer in the STP (166.6 ± 53.31 vs 130.4 ± 49.15). Five patients (2 vs 3) required reoperation (3.31%), while 13 patients (8.6%) required readmission.
Laparoscopic surgery for IBD performed by a supervised trainee is safe compared to trainers performed procedures despite a longer operating time. Randomized clinical trials are needed to confirm these preliminary results and to investigate long-term outcomes.
炎症性肠病（IBD）患者在其一生中存在手术切除的重大风险：腹腔镜手术已越来越多地应用于IBD的治疗，具有短期和长期优势。本研究的目的是证明由外科实习生在经验丰富的带教老师监督下进行的IBD腹腔镜手术是可行且安全的。
所有手术步骤被细分为六个关键步骤，以便将手术定义为带教老师未洗手在手术室内或协助时实习生进行的监督下实习生操作（STP），以及带教老师进行两个或更多关键步骤时的带教老师操作（TNER）。纳入2009年1月至2013年12月期间所有接受IBD腹腔镜切除术的患者。30天死亡率和发病率是主要结局。前瞻性记录出院后30天内的再次手术和再次住院情况，以及与转化率和住院时间一起作为次要结局。
纳入151例患者：77例（50.99%）为STP，74例（49.01%）为TNER。无死亡发生，30天发病率为27.15%，两组之间无差异。STP组的手术时间更长（166.6±53.31对130.4±49.15）。5例患者（2例对3例）需要再次手术（3.31%），而13例患者（8.6%）需要再次入院。
与带教老师进行的手术相比，由监督下的实习生进行的IBD腹腔镜手术尽管手术时间更长，但仍是安全的。需要进行随机临床试验以证实这些初步结果并研究长期结局。
