Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Department of Surgery, Mora Hospital, Mora, Sweden.
Surg Endosc. 2022 Jun;36(6):4602-4613. doi: 10.1007/s00464-021-08976-z. Epub 2022 Mar 14.
Surgical safety and patient-related outcomes are important considerations when introducing new surgical techniques. Studies about the learning curves for different surgical procedures are sparse. The aim of this observational study was to evaluate the learning curve for ultrasonic fundus-first (FF) dissection in elective laparoscopic cholecystectomy (LC).
The study was conducted at eight hospitals in Sweden between 2017 and 2019. The primary endpoint was dissection time, with secondary endpoints being intra- and postoperative complication rates and the surgeon's self-assessed performance level. Participating surgeons (n = 16) were residents or specialists who performed LC individually but who had no previous experience in ultrasonic FF dissection. Each surgeon performed fifteen procedures. Video recordings from five of the procedures were analysed by two external surgeons. Patient characteristics and data on complications were retrieved from the Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks).
Dissection time decreased as experience increased (p = 0.001). Surgeons with limited experience showed more rapid progress. The overall complication rate was 14 (5.8%), including 3 (1.3%) potentially technique-related complications. Video assessment scores showed no correlation with the number of procedures performed. The self-assessed performance level was rated lower when the operation was more complicated (p < 0.001).
Our results show that dissection time decreased with increasing experience. Most surgeons identified both favourable and unfavourable aspects of the ultrasonic FF technique. The ultrasonic device is considered well suited for gallbladder surgery, but most participating surgeons preferred to dissect the gallbladder the traditional way, beginning in the triangle of Calot. Nevertheless, LC with ultrasonic FF dissection can be considered easy to learn with a low complication rate during the initial learning curve, for both residents and specialists.
在引入新的外科技术时，手术安全性和患者相关结局是重要的考虑因素。关于不同手术程序学习曲线的研究很少。本观察性研究的目的是评估选择性腹腔镜胆囊切除术（LC）中超声下先游离胆囊底部（FF）技术的学习曲线。
本研究于 2017 年至 2019 年在瑞典的八家医院进行。主要终点是游离时间，次要终点是术中及术后并发症发生率和外科医生的自我评估绩效水平。参与的外科医生（n=16）是进行 LC 的住院医师或专家，但没有超声下 FF 游离的经验。每位外科医生完成了十五例手术。两名外部外科医生对其中五例手术的视频记录进行了分析。患者特征和并发症数据从瑞典胆囊结石手术和内镜逆行胰胆管造影术（GallRiks）登记处检索。
游离时间随经验的增加而减少（p=0.001）。经验有限的外科医生进步更快。总体并发症发生率为 14 例（5.8%），包括 3 例（1.3%）潜在与技术相关的并发症。视频评估评分与手术次数无相关性。手术越复杂，自我评估的绩效水平越低（p<0.001）。
我们的结果表明，游离时间随经验的增加而减少。大多数外科医生认为超声 FF 技术既有有利的方面，也有不利的方面。超声器械被认为非常适合胆囊手术，但大多数参与的外科医生更喜欢从 Calot 三角开始传统的游离胆囊方式。然而，对于住院医师和专家来说，LC 采用超声下 FF 游离技术具有易于学习、初始学习曲线期间并发症发生率低的特点。
