Ichikawa Nobuki, Homma Shigenori, Yoshida Tadashi, Iijima Hiroaki, Kawamata Futoshi, Sibasaki Susumu, Kawamura Hideki, Minagawa Nozomi, Kamiizumi You, Fukasaku Yasutomo, Taketomi Akinobu
Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University.
Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo.
Surg Laparosc Endosc Percutan Tech. 2020 Feb;30(1):49-54. doi: 10.1097/SLE.0000000000000740.
The actual proficiency levels of surgeons after their qualification by the Endoscopic Surgical Skill Qualification System have not been established. This study aimed to investigate whether technically qualified surgeons could safely perform laparoscopic low anterior resection and to evaluate the proficiency level at the time of certification acquisition. A total of 46 patients (mean age, 63.3 y; male to female ratio, 29:17) who underwent low anterior resection were included. Outcomes of 46 low anterior resections for rectal cancer performed by 3 novice surgeons certified by the Endoscopic Surgical Skill Qualification System from 2013 to 2018 at 2 hospitals were retrospectively assessed. The mean operative time and blood loss were 201 minutes and 12.9 mL, respectively. One patient (2.2%) required conversion to open surgery, and major postoperative complications occurred in 4 patients (8.6%), including anastomotic leakage in 2 patients (4.3%). Histologic R0 resection was achieved in all cases. The operative time moving average for the 3 surgeons gradually decreased from 233 to 158 minutes. In cumulative sum charts, the operative time values continuously decreased after the 12th case compared with the target operative time (180 min). In conclusion, surgeons can safely perform laparoscopic low anterior resection just after their qualification but have the potential to further attain proficiency.
外科医生通过内镜手术技能资格系统获得资格后的实际熟练程度尚未确定。本研究旨在调查技术合格的外科医生是否能够安全地进行腹腔镜低位前切除术，并评估获得认证时的熟练程度。共有46例接受低位前切除术的患者（平均年龄63.3岁；男女比例29:17）纳入研究。回顾性评估了2013年至2018年期间在2家医院由内镜手术技能资格系统认证的3名新手外科医生进行的46例直肠癌低位前切除术的结果。平均手术时间和失血量分别为201分钟和12.9毫升。1例患者（2.2%）需要转为开放手术，4例患者（8.6%）发生主要术后并发症，其中2例患者（4.3%）发生吻合口漏。所有病例均实现了组织学R0切除。3名外科医生的手术时间移动平均值从233分钟逐渐降至158分钟。在累积和图表中，与目标手术时间（180分钟）相比，第12例病例后的手术时间值持续下降。总之，外科医生在获得资格后即可安全地进行腹腔镜低位前切除术，但仍有进一步提高熟练程度的潜力。
