Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
Surg Endosc. 2019 Dec;33(12):3970-3975. doi: 10.1007/s00464-019-06685-2. Epub 2019 Feb 11.
Endoluminal vacuum therapy (EVAC) is an emerging procedure used to treat anastomotic leaks and/or perforations that would otherwise require surgery. The aim of this study was to determine time to proficiency in EVAC and the cost effectiveness of the procedure.
We retrospectively reviewed a prospectively maintained IRB approved database for all patients undergoing EVAC after esophageal and gastric complications between October 2013 and December 2017. Proficiency was determined by obtaining predicted estimates and analyzing the point at which average procedure time plateaued based on case volume. Total cost was calculated based on supplies and location where the procedure was performed.
There were 50 patients (17 males, 33 female), with a mean age of 52.1 years. EVAC was placed in 23 (46%) patients with esophageal injuries and 28 (56%) with gastric injuries. Two advanced endoscopists performed all EVAC procedures in this study (1 surgeon, 1 gastroenterologist). The average procedure time for all patients was 43.5 min and the average wheel in/wheel out time for all patients was 75.6 min. Analysis of the trend based on average procedure times for EVAC revealed that proficiency was obtained after 10 cases. Total cost of the procedure is significantly lower in the GI lab compared to the operating room ($4528 vs. $11889). The majority of EVAC were performed in the GI lab (62%) compared to the operating room (38%).
Successful outcomes in managing anastomotic leaks or intestinal perforations non-operatively has led to an increased interest in EVAC. For advanced endoscopists, time to proficiency is approximately 10 cases. Performing the procedure in the GI lab has a 2.5 reduction in total cost compared to the operating room.
腔内真空治疗（EVAC）是一种新兴的治疗方法，用于治疗吻合口漏和/或穿孔，否则需要手术。本研究旨在确定 EVAC 熟练程度的时间和该程序的成本效益。
我们回顾性地审查了 2013 年 10 月至 2017 年 12 月期间所有因食管和胃并发症而行 EVAC 的患者的前瞻性维护的 IRB 批准数据库。熟练程度通过获得预测估计并根据病例量分析平均程序时间稳定的点来确定。总成本基于用品和进行程序的位置计算。
共有 50 名患者（17 名男性，33 名女性），平均年龄为 52.1 岁。EVAC 放置在 23 例（46%）食管损伤患者和 28 例（56%）胃损伤患者中。本研究中，由 2 名高级内镜医生进行所有 EVAC 手术（1 名外科医生，1 名胃肠病学家）。所有患者的平均手术时间为 43.5 分钟，所有患者的平均进出轮时间为 75.6 分钟。根据 EVAC 的平均手术时间趋势分析表明，经过 10 例后获得熟练程度。与手术室相比，该程序在 GI 实验室的总成本显着降低（4528 美元与 11889 美元）。大多数 EVAC 在 GI 实验室进行（62%），而在手术室进行（38%）。
成功地以非手术方式治疗吻合口漏或肠穿孔导致对 EVAC 的兴趣增加。对于高级内镜医生来说，达到熟练程度大约需要 10 例。与手术室相比，在 GI 实验室进行该程序可将总成本降低 2.5 倍。
