Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
Surg Endosc. 2019 Jul;33(7):2242-2248. doi: 10.1007/s00464-018-6511-7. Epub 2018 Oct 22.
Recently, laparoscopic surgery (LS) has become a more common procedure than traditional open surgery. Although LS-related adverse events have been reported, there is no formal, standardized curriculum to teach the fundamentals of LS in Japan. Understanding surgeons' knowledge regarding LS is crucial for developing an educational curriculum. The purpose of this study was to determine the baseline knowledge on LS of surgeons and surgical trainees in Japan.
Participants completed 24 multiple-choice questions testing basic cognitive knowledge of LS and a questionnaire regarding the status of laparoscopic education. The examination was developed according to the 13 content domains of the Fundamentals of Laparoscopic Surgery (FLS) program. Scores were compared between post-graduate year (PGY) > 5 and PGY 1-5 participants. Data are expressed as median scores and interquartile ranges. Wilcoxon signed-rank test was used for statistical analysis.
A total of 195 surgeons and surgical trainees from 10 teaching hospitals (PGY1-5: 66, PGY > 5: 129) across Japan completed the examination. The median score in the entire cohort was 75 [67; 83] %, with significantly higher scores in the PGY > 5 group compared to the PGY1-5 group (79 [75; 83] % vs. 67 [58; 75] %, p < 0.001). The differences in performance were due to better scores for PGY > 5 group on the sections "equipment," "patient considerations," "abdominal access," "tissue handling," "hemorrhage and hemostasis," "tissue approximation," and "exiting the abdomen." Overall, the median scores in the "energy sources" and "establishment and physiology of the pneumoperitoneum" subsections were lower than in other domains. All participants agreed on the need for fundamental knowledge and a formal educational curriculum.
Compared to experienced surgeons, surgical trainees had lesser knowledge about performing LS. Regardless of the years of experience, there are crucial knowledge gaps in specific areas regarding safe LS that should be addressed by implementing an educational curriculum.
最近，腹腔镜手术（LS）已成为比传统开放手术更为常见的手术。尽管已经报道了与 LS 相关的不良事件，但在日本，尚无正式的标准化课程来教授 LS 的基础知识。了解外科医生对 LS 的了解对于制定教育课程至关重要。本研究的目的是确定日本外科医生和外科住院医师对 LS 的基本知识。
参与者完成了 24 个多项选择题，以测试他们对 LS 的基本认知知识，并回答了有关腹腔镜教育状况的问卷。该考试是根据腹腔镜手术基础（FLS）计划的 13 个内容领域制定的。将研究生后年（PGY）> 5 年和 PGY 1-5 年的参与者的分数进行比较。数据表示为中位数和四分位距。使用 Wilcoxon 符号秩检验进行统计分析。
来自日本 10 所教学医院的 195 名外科医生和外科住院医师（PGY1-5：66，PGY> 5：129）完成了考试。整个队列的中位数得分为 75 [67；83]％，PGY> 5 组的得分明显高于 PGY1-5 组（79 [75；83]％比 67 [58；75]％，p <0.001）。表现上的差异是由于 PGY> 5 组在“设备”，“患者注意事项”，“腹部通道”，“组织处理”，“出血和止血”，“组织逼近”和“腹部退出”等部分的得分更高。总体而言，“能源来源”和“气腹的建立和生理学”两个部分的中位数得分低于其他领域。所有参与者都同意需要基础知识和正式的教育课程。
与经验丰富的外科医生相比，外科住院医师对执行 LS 的了解较少。无论经验如何，在实施教育课程时，都应解决有关安全 LS 的特定领域的关键知识差距。
