Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 2320, Chicago, IL, 60611, USA.
Surg Endosc. 2021 Sep;35(9):5140-5146. doi: 10.1007/s00464-020-08003-7. Epub 2020 Oct 6.
Laparoscopic common bile duct exploration (LCBDE) is an underutilized therapy for choledocholithiasis. The driving factors of this practice gap are poorly defined. We sought to evaluate the attitudes and practice patterns of surgeons who underwent training courses using an LCBDE simulator.
Surgeons completed a half-day simulator-based LCBDE curriculum at national courses, including the American College of Surgeons Advanced Skills Training for Rural Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons annual meeting. Attitudes were assessed with Likert surveys immediately before and after curriculum completion. Follow-up surveys were distributed electronically.
159 surgeons completed training during six courses. Surgeon attitudes regarding the overall superiority of LCBDE vs. ERCP shifted towards favoring LCBDE after course participation (4.0 vs 3.3; Likert scale 1-5, p < 0.001). 44% of surgeons completed follow-up surveys at a mean of 3 years post-course. Surgeons remained confident in their ability to perform LCBDE, with only 14% rating their skill as a significant barrier to practice, as compared with 43% prior to course participation (p < 0.01). However, only 28% of surgeons saw an increase in LCBDE volume. Deficiencies in operating room (OR) staff knowledge and instrument availability were the most significant barriers to post-course practice implementation and were inversely correlated with LCBDE case volume (ρ = - 0.44 and - 0.47, both p < 0.01). Surgeons for whom OR staff knowledge of LCBDE was not a significant barrier performed nearly 4 times more LCBDE than those who rated staff knowledge as a moderate, strong, or complete barrier.
Surgeons trained at an LCBDE course retained long-term confidence in their procedural ability. Practice implementation was hindered by deficiencies in OR staff knowledge and instrument availability. Surgeons with knowledgeable operating room staff performed significantly more LCBDEs than those with less capable assistance. These barriers should be addressed in future curricula to improve procedural adoption.
腹腔镜胆总管探查术（LCBDE）是一种未充分利用的胆总管结石治疗方法。造成这种实践差距的驱动因素尚未明确。我们旨在评估接受 LCBDE 模拟器培训课程的外科医生的态度和实践模式。
外科医生在全国性课程中完成了为期半天的基于模拟器的 LCBDE 课程，包括美国外科医师学院农村外科医生高级技能培训课程和美国胃肠内镜外科医师学会年会。课程完成前后通过李克特量表评估态度。随后分发电子随访调查。
六次课程中有 159 名外科医生完成了培训。外科医生对 LCBDE 总体优于 ERCP 的态度在课程参与后转向支持 LCBDE（4.0 对 3.3；Likert 量表 1-5，p<0.001）。44%的外科医生在课程结束后 3 年进行了随访调查。外科医生对自己进行 LCBDE 的能力仍然有信心，只有 14%的人认为他们的技能是实践的重大障碍，而课程参与前有 43%的人认为（p<0.01）。然而，只有 28%的外科医生看到 LCBDE 量增加。手术室（OR）工作人员知识和仪器可用性的不足是术后实践实施的最大障碍，与 LCBDE 病例量呈负相关（ρ=-0.44 和-0.47，均 p<0.01）。OR 工作人员对 LCBDE 了解程度不是障碍的外科医生进行的 LCBDE 手术几乎是认为工作人员知识是中度、强或完全障碍的外科医生的 4 倍。
在 LCBDE 课程中接受培训的外科医生长期以来一直对自己的手术能力充满信心。手术实施受到手术室工作人员知识和仪器可用性不足的阻碍。具有知识渊博的手术室工作人员的外科医生进行的 LCBDE 明显多于能力较低的外科医生。在未来的课程中应解决这些障碍，以提高手术的采用率。
