Carter-Brooks Charelle M, Du Angela L, Bonidie Michael J, Shepherd Jonathan P
Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, 300 Halket Street, Suite, Pittsburgh, PA, 2323, USA.
Division of Urogynecology and Reconstructive Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Int Urogynecol J. 2018 Sep;29(9):1317-1323. doi: 10.1007/s00192-017-3468-3. Epub 2017 Sep 9.
Abdominal sacrocolpopexy is commonly performed for the surgical correction of pelvic organ prolapse (POP) in the USA. Over the last decade, fellowship programs have increased the number of these procedures performed robotically. Currently, there is a paucity of literature exploring the impact of fellowship training on outcomes of robotic-assisted sacrocolpopexy (RASC). We sought to explore the impact of an expert surgeon operating alone versus with a fellow on operative time and perioperative morbidity associated with RASC.
This is an analysis of a retrospectively collected cohort of all RASCs performed to treat POP from June 2010 to August 2015 by a single attending surgeon. Outcomes were compared by expert surgeon alone and with a fellow.
We identified 208 RASCs, of which 124 (59.6%) were performed by an expert surgeon alone and 84 (40.4%) with a fellow. Eight fellows were included, with a median of 7 cases (interquartile range 5-13.5). Cases with fellows were 31.1 min longer than an expert surgeon alone (155.6 vs 124.5 min, p < 0.001), a 25% increase. Increased operative time for fellows remained significant on multivariate regression (34.2 min, p < 0.001) after adjusting for case order postmenopausal status, hysterectomy, mid-urethral sling, and bowel injury. Years in fellowship did not have an impact on operative time (p = 0.80). Complications were seen in 34 women (16.4%). On univariate regression, fellows did not have an impact on complications (OR 1.49, 95% CI [0.65-3.43]), which was unchanged on multivariate regression (OR 0.628, 95% CI [0.26-1.54]). Prolapse recurrence was seen in 19 women (9.5%). Fellows had no impact on prolapse recurrence (OR 0.478, 95% CI [0.17-1.38]), which was unchanged on multivariate regression (OR 0.266, 95% CI [0.17-1.49]).
When an expert surgeon operated together with a fellow, operative time increased by 34 min without increasing prolapse recurrence or complications.
在美国，腹骶阴道固定术常用于盆腔器官脱垂（POP）的手术矫正。在过去十年中，专科培训项目增加了机器人辅助进行此类手术的数量。目前，关于专科培训对机器人辅助骶骨阴道固定术（RASC）结果影响的文献较少。我们试图探讨由专家外科医生单独操作与带住院医师一起操作对RASC手术时间和围手术期发病率的影响。
这是一项对2010年6月至2015年8月由一名主治外科医生进行的所有用于治疗POP的RASC手术的回顾性收集队列分析。比较专家外科医生单独操作和带住院医师一起操作的结果。
我们确定了208例RASC手术，其中124例（59.6%）由专家外科医生单独完成，84例（40.4%）是带住院医师一起完成。纳入了8名住院医师，平均参与7例手术（四分位间距为5 - 13.5例）。带住院医师的病例比专家外科医生单独操作的病例手术时间长31.1分钟（155.6分钟对124.5分钟，p < 0.001），增加了25%。在对病例顺序、绝经后状态、子宫切除术、尿道中段吊带术和肠损伤进行调整后，住院医师导致手术时间增加在多因素回归分析中仍具有统计学意义（34.2分钟，p < 0.001）。住院医师培训年限对手术时间没有影响（p = 0.80）。34名女性（16.4%）出现并发症。在单因素回归分析中，住院医师对并发症没有影响（比值比1.49，95%置信区间[0.65 - 3.43]），在多因素回归分析中这一结果不变（比值比0.628，95%置信区间[0.26 - 1.54]）。19名女性（9.5%）出现脱垂复发。住院医师对脱垂复发没有影响（比值比0.478，95%置信区间[0.17 - 1.38]），在多因素回归分析中这一结果不变（比值比0.266，95%置信区间[0.17 - 1.49]）。
当专家外科医生与住院医师一起操作时，手术时间增加了34分钟，但脱垂复发率和并发症并未增加。
