评估胃癌胃切除术的质量与完整性：对来自公共领域手术视频的回顾
Evaluating quality and completeness of gastrectomy for gastric cancer: review of surgical videos from the public domain.
作者信息
Dixon Matthew, Palter Vanessa, Brar Savtaj, Coburn Natalie
机构信息
Department of Surgery, University of Toronto, Toronto, ON, Canada.
St. Michaels Hospital, Toronto, ON, Canada.
出版信息
Transl Gastroenterol Hepatol. 2021 Oct 25;6:57. doi: 10.21037/tgh.2020.01.01. eCollection 2021.
BACKGROUND
YouTube has provided a forum to share surgical videos in the public domain which may be used for education. The quality of surgery and accompanying educational material is unknown. YouTube videos of gastrectomy with D2 lymphadenectomy (D2-LND) for gastric cancer were evaluated for quality and completeness.
METHODS
YouTube was searched using the terms "D2 lymphadenectomy" and "Gastric Cancer" for open and laparoscopic videos. The Korean Laparoscopic Gastrointestinal Surgical Society (KLASS) outlined 22 steps that define quality and completeness of D2-LND. These guidelines were used to score D2-LND for each video. Four physician reviewers independently scored each surgical video. Scores were compared using Student's -test.
RESULTS
Ten laparoscopic and 10 open surgery videos were assessed. Each video was scored for quality and completeness and assigned a score out of 22. Mean score for open D2-LND was 15 (95% CI: 12.54-17.46). Mean score for laparoscopic D2-LND was 15.4 (95% CI: 14.34-16.46; P=0.77). The most consistently performed steps were the dissection of lymph node stations 1, 3, 4 and 5. The most commonly omitted steps were the dissection of lymph node station 6: exposure and identification of the lowest anterior superior pancreaticoduodenal vein; removal of the prepancreatic soft tissues above the lowest anterior superior pancreaticoduodenal vein; removal of the prepancreatic soft tissues above the level of the bifurcation of the anterior superior pancreaticoduodenal vein and right gastroepiploic vein.
CONCLUSIONS
There is a wide range of quality and completeness of D2-LND videos. On average, D2-LND videos are only two-thirds complete.
背景
YouTube提供了一个在公共领域分享手术视频的平台，这些视频可用于教育。手术质量及配套教育材料的质量尚不清楚。对YouTube上有关胃癌D2淋巴结清扫术（D2-LND）的胃切除术视频的质量和完整性进行了评估。
方法
在YouTube上使用“D2淋巴结清扫术”和“胃癌”搜索开放手术和腹腔镜手术视频。韩国腹腔镜胃肠外科学会（KLASS）列出了22个步骤，用于定义D2-LND的质量和完整性。这些指南用于对每个视频的D2-LND进行评分。四位医生评审员独立对每个手术视频进行评分。使用学生t检验比较评分。
结果
评估了10个腹腔镜手术视频和10个开放手术视频。每个视频都进行了质量和完整性评分，并给出了22分制的分数。开放D2-LND的平均得分为15分（95%可信区间：12.54-17.46）。腹腔镜D2-LND的平均得分为15.4分（95%可信区间：14.34-16.46；P=0.77）。最常执行的步骤是第1、3、4和5组淋巴结的清扫。最常遗漏的步骤是第6组淋巴结的清扫：暴露和识别最低的胰十二指肠上前静脉；切除最低的胰十二指肠上前静脉上方的胰前软组织；切除胰十二指肠上前静脉和右胃网膜静脉分叉水平上方的胰前软组织。
结论
D2-LND视频的质量和完整性差异很大。平均而言，D2-LND视频仅完成了三分之二。
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