Gonzalez-Urquijo Mauricio, Hinojosa-Gonzalez David E, Rodarte-Shade Mario, Gil-Galindo Gerardo, Flores-Villalba Eduardo, Rojas-Mendez Javier
Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, NL, México.
Tecnologico de Monterrey, School of Engineering and Science, Av. Eugenio Garza Sada 2501 Sur, Tecnológico, 64849, Monterrey, NL, Mexico.
Surg Endosc. 2022 May;36(5):3110-3115. doi: 10.1007/s00464-021-08612-w. Epub 2021 Jun 22.
Even though the goal of safely performing cholecystectomy is already a priority in general surgical training programs, we aimed to study how many residents and attendings reached the critical view of safety (CVS) in laparoscopic cholecystectomy.
Retrospective review of prospectively collected data of all patients with biliary surgical conditions, which underwent laparoscopic cholecystectomy and their corresponding postoperative notes with self-reported CVS from May 2019 to May 2020 in an academic hospital. Comparisons of operative variables between postgraduate year and attendings were made.
Laparoscopic cholecystectomy was performed in 126 elective cases (62.6%) and 75 (37.3%) emergency cases. On 105 (83.3%) of the elective cases and on 54 (66.7%) emergency cases, a CVS was successfully performed. PGY3 and PGY5 had higher odds of achieving CVS compared to attendings OR 6.09 (95% CI 2.05 to 8.07) and 4.51 (95% CI 1.0 to 10.20), respectively. Overall, attendings had decreased odds ratio of achieving CVS of 0.488 when compared to all residents. Elective procedures had increased odds ratios of achieving CVS of 3.44 (95% CI 1.52 to 7.74). On elective cases, attendings performed significantly faster procedures when compared to PGY2-4, but not PGY5. No differences were seen between operative speeds between PGY. Third-year residents were identified as having the highest frequency of CVS; however, these differences were not statistically significant. In emergency cases, blood loss, operative time, CVS, and bile duct injuries revealed non-significant differences between operators.
CVS was reached significantly more often in elective than in emergency surgeries. There is still a lack of residents and attending surgeons who still failed to complete CVS during LC, highlighting the need for further education. Future studies should be attempted to repeat this study with a larger sample size and multiple coaching sessions to determine long-term efficacy.
尽管安全实施胆囊切除术的目标在普通外科培训项目中已是优先事项，但我们旨在研究有多少住院医师和主治医生在腹腔镜胆囊切除术中达到了安全关键视野（CVS）。
回顾性分析2019年5月至2020年5月在一家学术医院接受腹腔镜胆囊切除术的所有胆道外科疾病患者的前瞻性收集数据及其相应的自我报告CVS的术后记录。对研究生年级和主治医生之间的手术变量进行比较。
共进行了126例择期手术（62.6%）和75例急诊手术（37.3%）。在105例（83.3%）择期手术和54例（66.7%）急诊手术中成功实施了CVS。与主治医生相比，PGY3和PGY5实现CVS的几率更高，分别为OR 6.09（95%CI 2.05至8.07）和4.51（95%CI 1.0至10.20）。总体而言，与所有住院医师相比，主治医生实现CVS的优势比降低了0.488。择期手术实现CVS的优势比增加了3.44（95%CI 1.52至7.74）。在择期手术中，与PGY2 - 4相比，主治医生的手术速度明显更快，但与PGY5相比则无差异。PGY之间的手术速度未见差异。三年级住院医师被确定为CVS频率最高；然而，这些差异无统计学意义。在急诊手术中，失血、手术时间、CVS和胆管损伤在术者之间无显著差异。
择期手术中达到CVS的情况明显多于急诊手术。仍有一些住院医师和主治外科医生在LC期间未能完成CVS，这突出了进一步教育的必要性。未来的研究应尝试以更大的样本量和多次辅导课程重复本研究以确定长期疗效。
