Lavy Ron, Halevy Ariel, Hershkovitz Yehuda
Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
J Surg Educ. 2015 Sep-Oct;72(5):1014-7. doi: 10.1016/j.jsurg.2015.03.017. Epub 2015 May 14.
Laparoscopic cholecystectomy (LC) has been the gold standard for surgical treatment of gallbladder disease since 1980. This laparoscopic surgical procedure is one of the first to be performed by general surgery residents. There is a learning curve required to excel at performing LC. During this period, the operation needs to be performed under the supervision of a senior surgeon. The purpose of this study was to compare LC performed by residents with that performed by senior surgeons using the following parameters: operative time, conversion rate, complication rate, and mean length of hospital stay.
This retrospective study included 1219 patients who underwent elective LC in our institute-788 operated on by a senior surgeon and 431 by a resident.
The mean operative time was 39 ± 19 minutes. There was a significant difference between the groups, as the mean operative time for the resident group was 49.9 ± 13 compared with 33.7 ± 6 for the senior surgeon group. The overall conversion rate was 2.1%, the complication rate was 2.2%, and the mean length of hospital stay was 1.5 days. There were no statistically significant differences between the groups for these parameters.
The only significant difference between the groups was a longer operative time, as the conversion rate, complication rate, and mean length of stay were the same. Therefore, it is safe for LC to be performed by residents supervised by a senior surgeon.
自1980年以来,腹腔镜胆囊切除术(LC)一直是胆囊疾病外科治疗的金标准。这种腹腔镜手术是普通外科住院医师最早开展的手术之一。要熟练掌握LC手术需要经历一个学习曲线。在此期间,手术需要在资深外科医生的监督下进行。本研究的目的是比较住院医师和资深外科医生进行LC手术的以下参数:手术时间、中转率、并发症发生率和平均住院天数。
这项回顾性研究纳入了在我院接受择期LC手术的1219例患者,其中788例由资深外科医生进行手术,431例由住院医师进行手术。
平均手术时间为39±19分钟。两组之间存在显著差异,住院医师组的平均手术时间为49.9±13分钟,而资深外科医生组为33.7±6分钟。总体中转率为2.1%,并发症发生率为2.2%,平均住院天数为1.5天。这些参数在两组之间没有统计学上的显著差异。
两组之间唯一的显著差异是手术时间较长,中转率、并发症发生率和平均住院时间相同。因此,在资深外科医生的监督下,住院医师进行LC手术是安全的。