现场手术：极具教育意义还是有害？
Live surgery: highly educational or harmful?
机构信息
Department of Urology, Nuovo Ospedale Civile Sant' Agostino Estense (N.O.C.S.A.E.) di Baggiovara, University of Modena and Reggio Emilia, Modena, Italy.
Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
出版信息
World J Urol. 2018 Feb;36(2):171-175. doi: 10.1007/s00345-017-2118-1. Epub 2017 Nov 9.
PURPOSE
Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR).
METHODS
We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications.
RESULTS
From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP.
CONCLUSIONS
In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe.
目的
现场手术（LS）被认为是一种有用的教学机会。必须权衡其对患者安全的影响。本研究旨在评估在腹腔镜和机器人手术大会挑战赛（CILR）中，专家进行的一系列泌尿科 LS 手术的并发症发生率。
方法
我们呈现了一个来自于 12 次 CILR 事件（2004 年至 2015 年）的大型多机构多外科医生数据库，共有 224 例。根治性前列腺切除术（RP）是最常见的手术，同时也选择了一些复杂病例。主要衡量标准是术后并发症，并使用术后发病率指数（PMI）对术后并发症进行定量评估。
结果
从 12 次活动中，病例数量从 2004 年的 11 例增加到 2015 年的 27 例，外科医生总数达到 27 名。224 例（164 例腹腔镜手术和 60 例机器人手术）中有 26 例（11.6%）发生并发症：5 级 I 例，5 级 II 例，3 级 IIIa 例，12 级 IIIb 例和 1 级 V 例，后者来自腹腔镜囊肿切除术。与 RP 相比，囊肿切除术的 PMI 分析高 23 倍。
结论
考虑到手术的复杂性，在现场手术中，并发症的总体发生率较低。复杂手术的 PMI 并没有更高，而 RP 似乎非常安全。
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