Fujikawa Takahisa, Uemoto Yusuke, Matsuoka Taisuke
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Cureus. 2023 May 11;15(5):e38865. doi: 10.7759/cureus.38865. eCollection 2023 May.
Introduction Although laparoscopic liver resection (LLR) has gained widespread acceptance over the last decade, it is associated with a much steeper learning curve than other laparoscopic procedures. We currently perform a modified two-surgeon technique for LLR. We assessed the effect of our LLR technique on the surgical outcome and the learning curve of surgeons-in-training when pure non-anatomical LLR was performed. Methods Between 2017 and 2021, 118 LLRs were conducted at our institution, 42 of which were pure non-anatomical LLRs performed by five surgeons-in-training (with a career of 6-13 years). The perioperative outcomes of these cases were compared to those performed by the board-certified attending surgeon. Regarding the learning curve of surgeons-in-training, the duration of operation was used as an index of the proficiency level, and the number of surgical cases in which the surgeons reached the median duration of operation was examined. Results Mortality was zero, and neither postoperative bleeding nor bile leak was experienced in the whole cohort. There were no differences between surgeons-in-training and the board-certified surgeon in the duration of the operation, intraoperative blood loss, rate of postoperative complications, or length of postoperative stay (LOS). Among the operations performed by five surgeons-in-training, the rate of LLR with a difficulty score of 4 or higher was 52% (30%-75%). Concerning the learning curve, all five surgeons-in-training gradually shortened the duration of operation for each additional case and reached the median duration (218 minutes) by experiencing a median of five cases (3-8 cases). Conclusion A modified two-surgeon technique during LLR is feasible, with a relatively low number of cases (five cases) required to shorten the duration of operation in non-anatomical LLR. This technique is safe and beneficial to the education of surgeons-in-training.
引言 尽管腹腔镜肝切除术（LLR）在过去十年中已得到广泛认可，但与其他腹腔镜手术相比，其学习曲线要陡峭得多。我们目前采用改良的双术者技术进行LLR。我们评估了在进行单纯非解剖性LLR时，我们的LLR技术对外科手术结果以及培训中的外科医生学习曲线的影响。
方法 在2017年至2021年期间，我们机构进行了118例LLR，其中42例是由五名培训中的外科医生（从业年限6 - 13年）进行的单纯非解剖性LLR。将这些病例的围手术期结果与经委员会认证的主治医生所做的病例进行比较。关于培训中的外科医生的学习曲线，将手术时间作为熟练程度的指标，并检查外科医生达到手术时间中位数时的手术病例数。
结果 全组死亡率为零，未发生术后出血或胆漏。培训中的外科医生与经委员会认证的外科医生在手术时间、术中失血、术后并发症发生率或术后住院时间（LOS）方面没有差异。在五名培训中的外科医生所做的手术中，难度评分为4或更高的LLR发生率为52%（30% - 75%）。关于学习曲线，所有五名培训中的外科医生每增加一例手术，手术时间逐渐缩短，在经历中位数为五例（3 - 8例）后达到中位数时间（218分钟）。
结论 LLR期间的改良双术者技术是可行的，在非解剖性LLR中缩短手术时间所需的病例数相对较少（五例）。该技术安全且有利于培训中的外科医生的教育。
