Passerotti Carlo C, Cruz José A, Reis Sabrina T, Okano Marcelo T, Duarte Ricardo J, Srougi Miguel, Nguyen Hiep T
Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil.
Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
Curr Urol. 2016 Oct;9(3):138-142. doi: 10.1159/000442868. Epub 2016 Sep 20.
Currently, there is no standardized training protocol to teach surgeons how to deal with vascular injuries during laparoscopic procedures. The purpose of this study is to develop and evaluate the effectiveness of a standardized algorithm for managing vascular injury during laparoscopic nephrectomies.
The performance of 6 surgeons was assessed during 10 laparoscopic nephrectomies in a porcine model. During the first and tenth operations, an injury was made in the renal vein without warning the surgeon. After the first procedure, the surgeons were instructed on how to proceed in dealing with the vascular injury, according to an algorithm developed by the designers of this study. The performance of each surgeon before and after learning the algorithm was assessed.
After learning the algorithm there was a decreased blood loss from 327 ± 403.11 ml to 37 ± 18.92 ml (p = 0.031) and decreased operative time from 43 ± 14.53 min to 27 ± 8.27 min (p = 0.015). There was also improvement in the time to start lesion repair from 147 ± 117.65 sec to 51 ± 39.09 sec (p = 0.025). There was a trend toward improvement in the reaction time to the injury (22 ± 21.55 sec vs. 14 ± 6.39, p = 0.188), the time required to control the bleeding (50 ± 94.2 sec vs. 14 ± 6.95 sec, p = 0.141), and the total time required to completely repair of the vascular injury (178 ± 170.4 sec vs. 119 ± 183.87 sec, p = 0.302).
A standardized algorithm may help to reduce the potential risks associated with laparoscopic surgery. Further studies will help to refine and determine the benefits of standardized protocols such as that developed in this study for the management of life-threatening laparoscopic complications.
目前，尚无标准化培训方案指导外科医生如何在腹腔镜手术中处理血管损伤。本研究的目的是开发并评估一种用于管理腹腔镜肾切除术期间血管损伤的标准化算法的有效性。
在猪模型的10例腹腔镜肾切除术中评估6名外科医生的表现。在第一次和第十次手术期间，在未告知外科医生的情况下对肾静脉造成损伤。在第一次手术后，根据本研究设计者制定的算法，指导外科医生如何处理血管损伤。评估每位外科医生在学习该算法前后的表现。
学习该算法后，失血量从327±403.11毫升降至37±18.92毫升（p = 0.031），手术时间从43±14.53分钟降至27±8.27分钟（p = 0.015）。从发现损伤到开始修复损伤的时间也从147±117.65秒改善至51±39.09秒（p = 0.025）。对损伤的反应时间（22±21.55秒对14±6.39秒，p = 0.188）、控制出血所需时间（50±94.2秒对14±6.95秒，p = 0.141）以及完全修复血管损伤所需的总时间（178±170.4秒对119±183.87秒，p = 0.302）有改善趋势。
标准化算法可能有助于降低与腹腔镜手术相关的潜在风险。进一步的研究将有助于完善并确定标准化方案（如本研究中开发的用于处理危及生命的腹腔镜并发症的方案）的益处。
