Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,.
J Pediatr Surg. 2020 Oct;55(10):2080-2082. doi: 10.1016/j.jpedsurg.2019.11.023. Epub 2019 Dec 16.
Pediatric surgery trainees at our institution perform 15 to 20 supervised laparoscopic pyloromyotomies during their junior year, and are allowed to perform the operation independently without supervision during their senior year. We reviewed the outcomes of laparoscopic pyloromyotomies performed by senior trainees operating without supervision and compared them to experienced pediatric surgeons.
We did a retrospective reviewed of all unsupervised laparoscopic pyloromyotomies (n = 90) performed by the last 12 pediatric surgery fellows (2012-2018) during their senior year, and the most recent 90 consecutive laparoscopic pyloromyotomies performed by 9 experienced pediatric surgeons. Statistical significance was determined by T-test and Fisher's exact test. Data is expressed as mean (SD) or median (range). A p value of ≤0.05 was considered significant.
Mean age at surgery was 4.7 (SD: 1.6) and 5 (SD: 2.3) weeks in the trainees and surgeons group, respectively (p = 0.38). Mean operative time was 28 (SD: 13) minutes in the trainees group vs. 25 (SD: 10) minutes in the surgeons group (p = 0.09). Intraoperative complications occurred in 3 of 90 (2.7%) cases in the trainees group (three mucosal perforations, all detected during the operation, one repaired laparoscopically, two repaired open), and none in the surgeons group (p = 0.11). One postoperative complication requiring reoperation occurred in the trainees group (omentum eviscerated through an incision site), while none occurred in the surgeons group (p = 0.36). No incomplete pyloromyotomies occurred in either group. The median length of postoperative hospital stay was 1 (1 to 10) and 1 (1 to 6) days in the trainees and surgeons group, respectively (p = 0.63).
Senior trainees at high-volume training programs can perform unsupervised laparoscopic pyloromyotomies safely as a mean to promote surgical autonomy without compromising patient outcomes.
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本机构的小儿外科受训医师在本科的最后一年会进行 15 至 20 次监督下的腹腔镜幽门肌切开术，并在高年级时可在无监督的情况下独立进行该手术。我们回顾了在无监督下由高年级受训医师进行的腹腔镜幽门肌切开术的结果，并将其与有经验的小儿外科医师进行了比较。
我们对最后 12 位小儿外科住院医师（2012-2018 年）在高年级期间进行的 90 例未经监督的腹腔镜幽门肌切开术（n=90），以及 9 位有经验的小儿外科医师最近连续进行的 90 例腹腔镜幽门肌切开术进行了回顾性研究。通过 T 检验和 Fisher 确切检验确定统计学意义。数据表示为平均值（标准差）或中位数（范围）。p 值≤0.05 被认为具有统计学意义。
受训医师组和外科医师组的手术时平均年龄分别为 4.7（标准差：1.6）和 5（标准差：2.3）周（p=0.38）。受训医师组的平均手术时间为 28（标准差：13）分钟，外科医师组为 25（标准差：10）分钟（p=0.09）。受训医师组中有 3 例（2.7%）术中发生并发症（3 例黏膜穿孔，均在术中发现，1 例腹腔镜下修补，2 例开放修补），而外科医师组中无并发症（p=0.11）。受训医师组中有 1 例术后并发症需要再次手术（网膜通过切口脱出），而外科医师组中无并发症（p=0.36）。两组均无不完全幽门肌切开术。受训医师组和外科医师组的术后住院时间中位数分别为 1（1 至 10）和 1（1 至 6）天（p=0.63）。
在高容量培训计划中，高级受训医师可以安全地进行未经监督的腹腔镜幽门肌切开术，作为促进手术自主性的手段，而不会影响患者的结局。
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