Stam Maw, Draaisma W A, Pasker Pcm, Consten Ecj, Broeders Iamj
Department of surgery, Meander Medical Centre, PO box 1502, 3800 BM, Amersfoort, the Netherlands.
Int J Colorectal Dis. 2017 Jun;32(6):891-896. doi: 10.1007/s00384-017-2756-1. Epub 2017 Jan 13.
Sigmoid resection for diverticulitis is usually the first procedure performed when starting the learning process for laparoscopic colorectal surgery. The aim of this study is to evaluate the difficulty of laparoscopic sigmoid resection for diverticulitis in comparison to sigmoid malignancy in order to assess its role in the residents training program.
A cohort of patients was selected who suffered either from malignancy or recurrent diverticulitis in the sigmoid colon. Laparoscopic sigmoid resection was performed. The degree of difficulty was assessed by intraoperative complications and intraoperative technical challenges. Furthermore, take-overs from assistant to surgeon, surgeon to surgeon, and conversion were reported.
A total of 224 patients were included, 119 (53.1%) men and 105 (46.9%) women. Patients suffering from diverticulitis had significantly less co-morbidities than those with malignancies. In the diverticulitis group, there were significantly more technical challenges. There was a higher rate in take-overs from residents (p = 0.02) as well as surgeon to surgeon (p = 0.04). The rate of conversions was also significantly higher in the diverticulitis group (p = 0.03) when compared to the malignancy group.
The outcomes of our study show that diverticulitis may not be the ideal condition to start the learning process for laparoscopic colorectal surgery.
对于腹腔镜结直肠手术学习过程而言，乙状结肠憩室炎切除术通常是开展的首个手术。本研究旨在评估乙状结肠憩室炎的腹腔镜乙状结肠切除术与乙状结肠恶性肿瘤切除术相比的难度，以评估其在住院医师培训项目中的作用。
选取一组患有乙状结肠癌或复发性乙状结肠憩室炎的患者。实施腹腔镜乙状结肠切除术。通过术中并发症和术中技术挑战评估难度程度。此外，报告了从助手到术者、术者到术者的交接情况以及中转开腹情况。
共纳入224例患者，其中男性119例（53.1%），女性105例（46.9%）。患有憩室炎的患者合并症明显少于患有恶性肿瘤的患者。在憩室炎组，技术挑战明显更多。住院医师之间（p = 0.02）以及术者之间（p = 0.04）的交接率更高。与恶性肿瘤组相比，憩室炎组的中转开腹率也明显更高（p = 0.03）。
我们的研究结果表明，憩室炎可能并非开展腹腔镜结直肠手术学习过程的理想病症。
