Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, 050000, Hebei, China.
BMC Surg. 2023 Apr 17;23(1):92. doi: 10.1186/s12893-023-01987-8.
Compare and analyze clinical data of total laparoscopic pancreaticoduodenectomy (TLPD) cases for surgeons with / without first assistant experience (FAE) in TLPD. Probe influence of FAE in TLPD on the learning curve for an operator.
The clinical data of 239 patients, that underwent TLPD performed by two surgeons between January 2017 and January 2022) in our department, were consecutively collected and divided into two groups (A and B). Group A cases were operated by Surgeon A, with FAE of 57 TLPDs in our department prior to initial TLPD as an operator. Group B cases were operated by Surgeon B with no FAE of TLPD. Cumulative sum (CUSUM) method developed learning curves. Clinical data and both surgeons' learning curves were statistically compared between both groups.
Between both groups, no statistically significant variations were observed for pre-operative health conditions. Reduced surgical duration, blood loss and transfusion volume during surgery, together with reductions in major post-operative complication rates and reduced hospital/ICU stays were identified within Group A, having statistically significant variations. The technical plateau phases of the learning curves were approximately 25-41 cases and 35-51 cases, for Surgeon A and Surgeon B, respectively.
FAE in TLPD can accelerate the learning curve of TLPD for an operator, with safer surgical procedures and enhanced post-operative recovery.
比较和分析有/无第一助手经验（FAE）的外科医生进行全腹腔镜胰十二指肠切除术（TLPD）的临床数据。探讨 FAE 在 TLPD 中对术者学习曲线的影响。
连续收集了 2017 年 1 月至 2022 年 1 月期间我科两位外科医生进行的 239 例 TLPD 的临床资料，并将其分为两组（A 组和 B 组）。A 组病例由有 57 例 TLPD 第一助手经验的外科医生 A 操作。B 组病例由无 TLPD 第一助手经验的外科医生 B 操作。采用累积和（CUSUM）法绘制学习曲线。对两组患者的临床资料和两位外科医生的学习曲线进行统计学比较。
两组患者术前健康状况无统计学差异。A 组患者手术时间、术中出血量和输血量减少，主要术后并发症发生率降低，住院/ICU 时间缩短，差异有统计学意义。A 组和 B 组术者学习曲线的技术平台期分别约为 25-41 例和 35-51 例。
TLPD 中的 FAE 可以加速术者 TLPD 的学习曲线，使手术过程更安全，术后恢复更好。
