Homma Shigenori, Kawamata Futoshi, Yoshida Tadashi, Ohno Yosuke, Ichikawa Nobuki, Shibasaki Susumu, Kawamura Hideki, Takahashi Norihiko, Taketomi Akinobu
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Surg Laparosc Endosc Percutan Tech. 2017 Aug;27(4):295-300. doi: 10.1097/SLE.0000000000000426.
This study aimed to evaluate the feasibility and effectiveness of a comprehensive theoretical and hands-on training program in performing laparoscopic colonic resections under supervision of an expert surgeon.
Laparoscopic right colectomy was performed in 78 patients (10 with benign disease, 68 with carcinoma). Demographic, intraoperative, pathologic examination, and short-term outcome data were retrospectively compared between 25 patients operated by surgical residents (R group) and 53 patients operated by senior surgeons (S group). The residents who performed surgeries in the R group had between 1 and 6 years after graduation; no experience with open or laparoscopic colorectal surgery was necessary. The residents completed a training program under supervision of a single expert laparoscopic colorectal surgeon, which included 6 steps, from basic skills to certification.
There were no differences in patient age, sex, and body mass index between the R and S groups. Significantly more patients in the R group had early cancer and benign lesions (P<0.05). Thirteen of the 16 residents (81.2 %) had not had prior experience with colonic resection. The time of suturing and knot tying in the dry box did not differ between residents and senior surgeons (68 and 69 s, respectively). All the residents performed laparoscopic right colectomy without intraoperative complications. There were no significant differences in operating time (R group: 173±34 min, S group: 172±52 min), mean estimated blood loss (50±111 vs. 49±100 mL), number of lymph nodes dissected (20.8±12.8 vs. 17.1±9.0), and mean postoperative hospital stay (9.1±3.3 vs. 10.7±4.1 d). On the basis of the year of their residency period, all 3 residents at 6 years after graduation had far greater experience than the other residents and therefore performed the surgery with minor verbal support from the expert. However, residents with 1 or 2 years after graduation had to receive guidance provision by the expert during surgery.
When supervised and led by an expert laparoscopic surgeon, surgical residents are capable of performing laparoscopic surgery without negative effects on outcomes.
本研究旨在评估在专家外科医生监督下进行腹腔镜结肠切除术的综合理论与实践培训计划的可行性和有效性。
对78例患者（10例良性疾病，68例癌症）进行腹腔镜右半结肠切除术。回顾性比较25例由外科住院医师手术的患者（R组）和53例由资深外科医生手术的患者（S组）的人口统计学、术中、病理检查及短期结局数据。R组中进行手术的住院医师毕业后有1至6年工作经验；无需有开放或腹腔镜结直肠手术经验。住院医师在一名腹腔镜结直肠外科专家的监督下完成了一个培训计划，该计划包括从基本技能到认证的6个步骤。
R组和S组患者的年龄、性别和体重指数无差异。R组中早期癌症和良性病变患者明显更多（P<0.05）。16名住院医师中有13名（81.2%）此前没有结肠切除术经验。住院医师和资深外科医生在干箱中缝合和打结的时间无差异（分别为68秒和69秒）。所有住院医师均成功完成腹腔镜右半结肠切除术，术中无并发症。手术时间（R组：173±34分钟，S组：172±52分钟）、平均估计失血量（50±111 vs. 49±100毫升）、清扫淋巴结数量（20.8±12.8 vs. 17.1±9.0）及术后平均住院时间（9.1±3.3 vs. 10.7±4.1天）均无显著差异。根据住院年限，毕业后6年的所有3名住院医师比其他住院医师经验丰富得多，因此在专家的少量口头支持下进行手术。然而，毕业后1年或2年的住院医师在手术期间必须接受专家的指导。
在专家腹腔镜外科医生的监督和指导下，外科住院医师能够进行腹腔镜手术，且不会对手术结局产生负面影响。
