Department of Surgery, School of Medicine, University of California, Riverside, Riverside, CA, USA.
Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Am Surg. 2020 Oct;86(10):1318-1323. doi: 10.1177/0003134820964430. Epub 2020 Oct 25.
Robotic surgery has increased for common general surgery procedures. This study evaluates how robotic use affects the case distributions of herniorrhaphy and cholecystectomy for general surgery residents according to postgraduate year (PGY). We reviewed Accreditation Council for Graduate Medical Education (ACGME) biliary or hernia cases logged by surgical residents in the academic year 2017-2018. Operative reports were reviewed to compare approaches (robotic, laparoscopic, and open) by resident role and PGY level. Open cholecystectomies were excluded. Overall, 470 hernia and 657 cholecystectomy cases were logged. Hernia repairs were performed robotically in 15.9%, laparoscopically in 9.5%, and open in 74.7%. Cholecystectomies were performed robotically in 16.4% and laparoscopically in 83.6%. Residents were teaching assistants in 1.8% of hernia repairs and 1.5% of cholecystectomies. Distribution of cases by technique and PGY level was significantly different for both procedures, with chief residents performing the majority of robotic cholecystectomies (52.6%, < .0001) and hernia repairs (59.7%, < .0001). Migration of robotic cases to senior resident level and low percentage of teaching assistant roles held by residents suggest exposure to common operations may be delayed during general surgery residency training. Introduction of new technology in surgical training should be carefully reviewed and may benefit from a structured curriculum.
机器人手术在普通普外科手术中的应用有所增加。本研究评估了机器人的使用如何根据住院医师规范化培训年限（PGY）影响普外科住院医师疝修补术和胆囊切除术的病例分布。我们回顾了 2017-2018 学年外科住院医师在住院医师规范化培训认证委员会（ACGME）登记的胆道或疝病例。通过住院医师的角色和 PGY 水平，对手术报告进行了比较，以比较手术方式（机器人、腹腔镜和开放）。排除开放性胆囊切除术。总共记录了 470 例疝和 657 例胆囊切除术病例。疝修补术的机器人辅助治疗比例为 15.9%，腹腔镜治疗比例为 9.5%，开放治疗比例为 74.7%。胆囊切除术的机器人辅助治疗比例为 16.4%，腹腔镜治疗比例为 83.6%。疝修补术和胆囊切除术的教学助理比例分别为 1.8%和 1.5%。这两种手术的技术和 PGY 水平的病例分布存在显著差异，主要住院医师进行了大多数机器人胆囊切除术（52.6%，<0.0001）和疝修补术（59.7%，<0.0001）。机器人手术向高年资住院医师水平转移，以及住院医师担任教学助理的比例较低，表明普外科住院医师培训期间，常见手术的暴露可能会延迟。在外科培训中引入新技术应仔细审查，可能受益于结构化课程。
