Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK.
altauro AG, Basel, Switzerland.
Ann R Coll Surg Engl. 2022 Jan;104(1):28-34. doi: 10.1308/rcsann.2020.7103.
Training a fellow has a cost in time and effort for the surgeon and their team. Their relative inexperience may also negatively affect the patient. The aim of this study was to determine and quantify the impact of a fellow on a regional robotic-assisted partial nephrectomy service and on perioperative outcomes.
We reviewed the prospectively collected data for 522 patients who had undergone robotic-assisted partial nephrectomy since 2015 during the tenure of six fellows. Perioperative outcomes for three groups were compared: group A (no fellow participation), group B (some participation) and group C (fellow completed entire operation). We also reviewed progression over 12 months.
Demographics were similar in all groups apart from the percentage of men, which was lower in group C (< 0.05). Operative time was 27 minutes longer for group B (< 0.001). Warm ischaemia time was significantly shorter for group A but the difference was only four minutes (< 0.001). Length of stay was slightly shorter for group C compared with the other groups (< 0.01). Trifecta achievement was greatest for group A (< 0.001). There were no perioperative deaths in any group and positive margins, complications and readmissions were low and similar in all groups. Towards the end of their fellowship, fellows performed more operations independently.
There is a measurable, but small, negative impact of a fellow on a robotic-assisted partial nephrectomy service, which reduces with experience. With appropriate supervision and patient selection, a fellow can be taught robotic-assisted partial nephrectomy without affecting patient safety or treatment outcome.
培训一名住院医师需要外科医生及其团队付出时间和精力。他们相对缺乏经验也可能对患者产生负面影响。本研究旨在确定并量化住院医师对区域性机器人辅助部分肾切除术服务以及围手术期结果的影响。
我们回顾了 2015 年以来 522 名接受机器人辅助部分肾切除术患者的前瞻性收集数据，期间有 6 名住院医师参与。比较了三组患者的围手术期结果：A 组（无住院医师参与）、B 组（部分参与）和 C 组（住院医师完成整个手术）。我们还回顾了 12 个月的进展情况。
除男性比例外，各组患者的人口统计学特征相似，而 C 组的男性比例较低（<0.05）。B 组的手术时间延长了 27 分钟（<0.001）。A 组的热缺血时间明显缩短，但仅为 4 分钟（<0.001）。C 组的住院时间与其他组相比略短（<0.01）。A 组 trifecta 达成率最高（<0.001）。三组均无围手术期死亡，阳性切缘、并发症和再入院率低且相似。住院医师在其住院医师培训的后期独立完成了更多的手术。
住院医师对机器人辅助部分肾切除术服务有一定的负面影响，但可测量且较小，经验丰富后这种影响会减少。在适当的监督和患者选择下，住院医师可以接受机器人辅助部分肾切除术的培训，而不会影响患者的安全或治疗效果。
