腹腔镜 Roux-en-Y 胃旁路术能否由减肥中心的住院医师安全实施？减肥手术住院医师的学习曲线。
Can a laparoscopic Roux-en-Y gastric bypass be safely performed by surgical residents in a bariatric center-of-excellence? The learning curve of surgical residents in bariatric surgery.
机构信息
Department of Metabolic and Bariatric Surgery, Medical Center Slotervaart, Louwesweg 6, PO box 90440, 1006 BK, Amsterdam, The Netherlands.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
出版信息
Surg Endosc. 2018 Feb;32(2):1012-1020. doi: 10.1007/s00464-017-5779-3. Epub 2017 Sep 21.
BACKGROUND
A learning curve (LC) is a graphic display of the number of consecutive procedures performed necessary to reach competence and is defined by complications and duration of surgery (DOS). There is little evidence on the LC of surgical residents in bariatric surgery. Aim of the study is to evaluate whether the laparoscopic Roux-en-Y gastric bypass (LRYGB) can be safely performed by surgical residents, to evaluate the LC of surgical residents for LRYGB and to assess whether surgical residents fit in the LC of the bariatric center which has been established by their proctors.
METHODS
Records of all 3389 consecutive primary LRYGB patients, operated between December 2007 and January 2016 in a bariatric center-of-excellence in Amsterdam, were reviewed. Differences in DOS were assessed by means of a linear regression model. Differences in complications (classified as Clavien-Dindo ≥ 2) were evaluated with the χ or the Fisher exact test. Cases were clustered in groups of 70 for comparison and reported for residents with ≥70 cases as primary surgeon.
RESULTS
Four surgeons (S1-4) and three residents (R1-3) performed 2690 (88.2%) and 361 (11.8%) of 3051 LRYGBs, respectively. Median (IQR) DOS was 52.0 (42.0-65.0) min for S1-4 versus 53.0 (46.0-63.0) min for R1-3 (p = 0.52). The LC of R1-3 in their first 70 cases (n = 210) differs significantly from the individual (n = 70) LCs of surgeon 1, 2, and 3, with remarkably shorter DOS for the residents (adjusted p < 0.0001; p < 0.001 and p = 0.0002, respectively) and the same amount of surgical complications 5.1% (137/2690) for S1-4 versus 3.0% (11/361) for R1-3 (p = 0.089).
CONCLUSION
Laparoscopic Roux-en-Y gastric bypass can be safely performed by surgical residents under supervision of experienced bariatric surgeons. Surgical residents benefit from the experience of their proctors and they fit faultlessly in the LC of the surgical team, as set out by their proctors in a large bariatric center-of-excellence.
背景
学习曲线（LC）是一种显示完成必要的连续手术次数以达到熟练程度的图形表示，由手术的并发症和持续时间（DOS）定义。关于减重手术中外科住院医师的 LC 数据很少。本研究旨在评估外科住院医师是否可以安全地进行腹腔镜 Roux-en-Y 胃旁路术（LRYGB），评估外科住院医师进行 LRYGB 的 LC，并评估外科住院医师是否符合其导师在减重中心建立的 LC。
方法
回顾 2007 年 12 月至 2016 年 1 月期间在阿姆斯特丹的卓越减重中心进行的 3389 例连续原发性 LRYGB 患者的记录。通过线性回归模型评估 DOS 的差异。使用 χ 或 Fisher 精确检验评估并发症（Clavien-Dindo≥2 级）的差异。将病例聚类为 70 例一组进行比较，并报告主要手术医师的≥70 例病例。
结果
四位外科医生（S1-4）和三位住院医师（R1-3）分别进行了 2690 例（88.2%）和 361 例（11.8%）的 3051 例 LRYGB 手术。S1-4 的中位（IQR）DOS 为 52.0（42.0-65.0）分钟，而 R1-3 的 DOS 为 53.0（46.0-63.0）分钟（p=0.52）。R1-3 在其前 70 例（n=210）中的 LC 与外科医生 1、2 和 3 的个体（n=70）LC 显著不同，住院医师的 DOS 明显缩短（调整后 p<0.0001；p<0.001 和 p=0.0002），而手术并发症的数量相同 5.1%（137/2690）对于 S1-4 与 3.0%（11/361）对于 R1-3（p=0.089）。
结论
腹腔镜 Roux-en-Y 胃旁路术可在经验丰富的减重外科医生的监督下由外科住院医师安全进行。外科住院医师受益于其导师的经验，并且他们在大型减重中心建立的外科团队的 LC 中表现出色，符合他们导师的要求。
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