Moore Maureen D, Afaneh Cheguevera, Gray Katherine D, Panjwani Suraj, Fahey Thomas J, Pomp Alfons, Zarnegar Rasa
Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
J Surg Res. 2017 Nov;219:98-102. doi: 10.1016/j.jss.2017.05.127. Epub 2017 Jun 28.
Nissen fundoplication is considered an advanced minimally invasive procedure whether performed laparoscopically or robotically. In laparoscopic surgery, it is evident that assistant skill level impacts operative times. However, the robotic platform allows improved surgeon autonomy. We aimed to determine the impact of assistant training level on operative times in robotic Nissen fundoplication (RNF) and laparoscopic Nissen fundoplication (LNF).
A prospectively maintained Nissen database (2011-2016) from a single academic institution was utilized to collect patient characteristics, operative times, length of stay, intraoperative complications, postoperative complications, readmission rate, and assistant training level. Assistants were either postgraduate year-3 surgery residents defined as junior-level assistants or a minimally invasive surgery (MIS) fellow defined as senior-level assistants.
There were 105 patients included in our analyses. When comparing postgraduate year-3 residents to MIS fellows performing LNF, the median operative time was significantly decreased when senior-level assistants were present in the LNF group, 85 (75-103) versus 129 (74-269) min, P = 0.02. In comparison, median operative times in the RNF group were independent of the assistant's level of training, 154 (71-300) versus 158 (101-215) min, P = 0.34. There were no significant differences in outcomes between the junior- and senior-level assistant cohorts for estimated blood loss, length of stay, postoperative complications, and 30-d readmission rates in either the LNF or RNF group.
Assistant training level impacted operative time for LNF but not RNF. These differences are most likely attributed to increased autonomy of the operating surgeon afforded by the robotic platform reducing assistant variability.
无论是通过腹腔镜还是机器人手术进行，nissen胃底折叠术都被视为一种先进的微创手术。在腹腔镜手术中，很明显助手的技术水平会影响手术时间。然而，机器人平台可提高外科医生的自主性。我们旨在确定助手培训水平对机器人nissen胃底折叠术（RNF）和腹腔镜nissen胃底折叠术（LNF）手术时间的影响。
利用来自单一学术机构的前瞻性维护的nissen数据库（2011 - 2016年）收集患者特征、手术时间、住院时间、术中并发症、术后并发症、再入院率和助手培训水平。助手要么是定义为初级助手的三年级外科住院医师，要么是定义为高级助手的微创手术（MIS）研究员。
我们的分析纳入了105例患者。将三年级住院医师与进行LNF的MIS研究员进行比较时，LNF组有高级助手时，中位手术时间显著缩短，分别为85（75 - 103）分钟和129（74 - 269）分钟，P = 0.02。相比之下，RNF组的中位手术时间与助手的培训水平无关，分别为154（71 - 300）分钟和158（101 - 215）分钟，P = 0.34。在LNF或RNF组中，初级和高级助手队列在估计失血量、住院时间、术后并发症和30天再入院率方面的结果没有显著差异。
助手培训水平影响LNF的手术时间，但不影响RNF的手术时间。这些差异很可能归因于机器人平台赋予手术医生更高的自主性，减少了助手的变异性。
