Shibuya Soichi, Fujiwara Naho, Ochi Takanori, Wada Momoko, Takahashi Toshiaki, Lee Kyeong Deok, Miyazaki Eiji
Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
BMC Surg. 2019 Jan 14;19(1):6. doi: 10.1186/s12893-019-0470-3.
Laparoscopic percutaneous extraperitoneal closure (LPEC) has become a common procedure for repairing inguinal hernia. As a laparoscopic approach, pediatric surgical trainees require more training to learn LPEC than a traditional open approach. This study aimed to clarify the experience needed to acquire the skill to perform LPEC adequately.
This descriptive single-center study used clinical data from patients who underwent LPEC between May 2009 and May 2016. The mean operative time for ten consecutive unilateral repairs was used as an index of proficiency with the procedure. The number of repairs performed before the mean operative time became less than 20 min was evaluated for each trainee.
During the study period, six pediatric surgical trainees participated in the training independently. The number of the patients was 987. The total number of repairs was 1436, including 538 unilateral repairs and 449 concurrent bilateral repairs. Overall, the mean operative time was 21.8 ± 8.1 min for unilateral repair and 31.4 ± 9.7 min for concurrent bilateral repairs. The mean number of repairs performed before the acquisition of skill for dexterous LPEC was 125.1 ± 29.5.
Although there were individual differences, all trainees acquired the skill to perform LPEC adequately within one year. With appropriate guidance, LPEC can become a standard technique for pediatric surgical trainees, along with traditional open surgery. These results provide valuable information for planning LPEC training.
腹腔镜经皮腹膜外修补术（LPEC）已成为腹股沟疝修补的常见术式。作为一种腹腔镜手术方式，小儿外科实习生学习LPEC所需的培训比传统开放手术更多。本研究旨在明确充分掌握LPEC操作技能所需的经验。
这项描述性单中心研究使用了2009年5月至2016年5月期间接受LPEC手术患者的临床资料。连续10例单侧修补术的平均手术时间用作该手术熟练程度的指标。评估每位实习生在平均手术时间少于20分钟之前所进行的修补手术数量。
在研究期间，6名小儿外科实习生独立参与了培训。患者总数为987例。修补手术总数为1436例，包括538例单侧修补和449例同期双侧修补。总体而言，单侧修补的平均手术时间为21.8±8.1分钟，同期双侧修补的平均手术时间为31.4±9.7分钟。熟练掌握LPEC操作技能之前所进行的平均修补手术数量为125.1±29.5例。
尽管存在个体差异，但所有实习生均在一年内充分掌握了LPEC操作技能。在适当的指导下，LPEC可以与传统开放手术一样，成为小儿外科实习生的标准技术。这些结果为规划LPEC培训提供了有价值的信息。
