Valinoti Agustin C, Dreifuss Nicolas H, Angeramo Cristian A, Schlottmann Francisco
Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Surg Laparosc Endosc Percutan Tech. 2020 Oct 16;31(2):223-226. doi: 10.1097/SLE.0000000000000870.
Laparoscopic appendectomy (LA) is a common procedure among surgical trainees. However, first-year residents' involvement in this procedure is scarcely studied. We aimed to determine the safety and outcomes of LA performed by surgical interns early in their first year of surgical training.
A retrospective review of all patients who underwent LA for acute appendicitis from 2006 to 2019 was performed. All patients operated by surgical interns were included. The sample was divided into 2 groups: LA performed during the first (G1) and last 3 months (G2) of their first year of residency. Demographics, operative variables, and postoperative outcomes were compared between groups.
A total of 2009 LA were performed during the study period; 1647 (82%) were done by surgical interns. A total of 934 LA were performed at both ends of the year; 505 belonged to G1 and 429 to G2. Each surgical intern performed a mean of 40 LA. Demographics, complicated appendicitis rates, and presence of peritonitis were comparable between groups. Operative time was longer in G1 (G1: 61 vs. G2: 52 min, P<0.0001). Major morbidity (G1: 2.1% vs. G2: 3.4%, P=0.2), postoperative intra-abdominal abscess rates (G1: 2.8% vs. G2: 2.8%, P=0.66), median length of hospital stay (G1: 1.9 vs. G2: 1.8 d, P=0.59), and readmission rates (G1: 1.6% vs. G2: 2%, P=0.73) were similar between groups. There was no mortality in the series.
LA can be safely performed by supervised surgical interns early in their training. Despite a longer operative time, postoperative outcomes were favorable and similar as those achieved at the end of surgical internship.
腹腔镜阑尾切除术（LA）是外科实习生常见的手术操作。然而，关于一年级住院医师参与该手术的研究却很少。我们旨在确定外科实习医生在外科培训第一年早期进行LA的安全性和手术效果。
对2006年至2019年期间所有因急性阑尾炎接受LA的患者进行回顾性研究。纳入所有由外科实习医生实施手术的患者。样本分为两组：在住院医师第一年的前3个月（G1）和后3个月（G2）进行的LA。比较两组患者的人口统计学资料、手术变量和术后结果。
研究期间共进行了2009例LA；其中1647例（82%）由外科实习医生完成。在年初和年末共进行了934例LA；505例属于G1组，429例属于G2组。每位外科实习医生平均进行40例LA。两组患者的人口统计学资料、复杂性阑尾炎发生率和腹膜炎情况相当。G1组的手术时间更长（G1组：61分钟 vs. G2组：52分钟，P<0.0001）。两组的主要发病率（G1组：2.1% vs. G2组：3.4%，P=0.2）、术后腹腔内脓肿发生率（G1组：2.8% vs. G2组：2.8%，P=0.66）、中位住院时间（G1组：1.9天 vs. G2组：1.8天，P=0.59）和再入院率（G1组：1.6% vs. G2组：2%，P=0.73）相似。该系列中无死亡病例。
在监督下，外科实习医生在培训早期即可安全地进行LA。尽管手术时间较长，但术后结果良好，与外科实习期末的结果相似。
