Warner Rachel L, Coleman K Conley, Musgrove Kelsey A, Bardes James M, Borgstrom David C, Grabo Daniel J
Department of Surgery, West Virginia University, Morgantown, WV, USA.
Department of Surgery, West Virginia University, Morgantown, WV, USA.
Am J Surg. 2020 Oct;220(4):899-904. doi: 10.1016/j.amjsurg.2020.02.032. Epub 2020 Feb 16.
Use of minimally invasive techniques for management of common bile duct (CBD) stones has led to declining number of CBD explorations (CBDE) performed at teaching and non-teaching institutions. We evaluate the impact of this decline on surgery training in bile duct procedures.
National operative data for general surgery residents (GSR) were examined from 2000 to 2018. Biliary operations including, cholecystectomy open and laparoscopic, and CBDE open and laparoscopic were evaluated for mean number of cases per graduating GSR.
Despite increases in number of GSR, case numbers for laparoscopic cholecystectomy increased 39% from 84 to 117, p < .00001, per GSR. Mean number of cases for open CBDE, however, decreased 74% from 2.7 to 0.7, p < .00001, per GSR and laparoscopic CBDE declined 22% from 0.9 to 0.7 per resident.
GSR operative case volume in CBDE has declined significantly creating a training deficiency for this complex skill. Novel simulation, including fresh cadavers, may offer the best option with high-fidelity, dynamic training to mitigate the loss of low volume, high acuity procedures.
使用微创技术治疗胆总管（CBD）结石导致教学机构和非教学机构进行的胆总管探查术（CBDE）数量减少。我们评估了这种减少对胆管手术培训的影响。
检查了2000年至2018年普通外科住院医师（GSR）的全国手术数据。评估了包括开腹和腹腔镜胆囊切除术以及开腹和腹腔镜CBDE在内的胆道手术，计算每位毕业GSR的平均病例数。
尽管GSR数量增加，但每位GSR的腹腔镜胆囊切除术病例数从84例增加到117例，增幅为39%，p <.00001。然而，每位GSR的开腹CBDE平均病例数从2.7例减少到0.7例，降幅为74%，p <.00001，每位住院医师的腹腔镜CBDE从0.9例下降到0.7例，降幅为22%。
GSR在CBDE方面的手术病例量显著下降，造成了这项复杂技能的培训不足。包括新鲜尸体在内的新型模拟可能提供最佳选择，通过高保真、动态培训来减轻低容量、高难度手术的损失。
