Kameda Chizu, Watanabe Masato, Suehara Nobuhiro, Watanabe Yusuke, Nishihara Kazuyoshi, Nakano Toru, Nakamura Masafumi
Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecyou Kita-ku, Sakai, 591-8025, Japan.
Surg Today. 2018 Feb;48(2):211-216. doi: 10.1007/s00595-017-1569-8. Epub 2017 Jul 19.
This study aimed to evaluate the surgical outcomes and clinical safety of laparoscopic distal gastrectomy (LDG) when performed by trainee surgeons with little prior experience in performing open gastrectomy, under the guidance of trainer surgeons.
From January 2008 until March 2015, 17 trainee surgeons and 5 trainer surgeons performed LDGs to treat 371 patients with clinical stage T1-T3 gastric cancer. Of these patients, 140 and 231 underwent LDG performed by trainee surgeons and trainer surgeons, respectively. We retrospectively analyzed the surgical outcomes of the two groups.
Trainee surgeons required significantly longer operation times than the trainer surgeons, with respective mean operation times of 262 and 223 min (p < 0.001). However, the mean blood loss volumes, average numbers of retrieved lymph nodes, postoperative complications, and postoperative hospital stay lengths did not differ significantly between LDGs performed by trainee surgeons and trainer surgeons.
The study findings suggest that, under the guidance of trainer surgeons, trainee surgeons with little experience with open gastrectomy and even without prior experience with LDG can perform radical surgeries safely.
本研究旨在评估在带教医师指导下，由几乎没有开腹胃切除术经验的实习医师进行腹腔镜远端胃切除术（LDG）的手术效果和临床安全性。
从2008年1月至2015年3月，17名实习医师和5名带教医师对371例临床分期为T1 - T3期的胃癌患者实施了LDG手术。其中，实习医师和带教医师分别对140例和231例患者进行了LDG手术。我们对两组的手术效果进行了回顾性分析。
实习医师的手术时间显著长于带教医师，平均手术时间分别为262分钟和223分钟（p < 0.001）。然而，实习医师和带教医师实施的LDG手术在平均失血量、平均淋巴结清扫数量、术后并发症及术后住院时间方面差异均无统计学意义。
研究结果表明，在带教医师的指导下，几乎没有开腹胃切除术经验甚至没有腹腔镜远端胃切除术经验的实习医师也能够安全地实施根治性手术。
