Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Anticancer Res. 2023 Jul;43(7):3341-3348. doi: 10.21873/anticanres.16510.
BACKGROUND/AIM: Recently, laparoscopic colectomy with intracorporeal anastomosis for colon cancer gained popularity due to the evolution of the laparoscopic linear stapler device and improved techniques from laparoscopic surgeons. However, there are technical difficulties associated with intracorporeal anastomosis. The aim of the study was to clarify the number of cases that are required for laparoscopic surgeons to master the technique of intracorporeal anastomosis in right side colon cancer.
In this retrospective single-center study, 51 consecutive patients who underwent intracorporeal overlap anastomosis, between July 2018 and March 2020, by one laparoscopic surgeon were selected. Clinicopathological and perioperative data were obtained from our database. The learning curves of intracorporeal anastomosis time (IAT) were created using the cumulative sum (CUSUM) method.
The CUSUM score for IAT increased as the number of operative cases progressed, up to the 20 case (Phase 1), after which it started to decrease (Phase 2). Compared to the initial learning phase (Phase 1), the master phase (Phase 2) had a significantly faster IAT (p<0.001), significantly decreased incidence of organ/space surgical site infection (p=0.009), and significantly decreased postoperative hospital stay (p=0.021).
Twenty cases were required for a laparoscopic surgeon to achieve expertise when conducting intracorporeal anastomosis in laparoscopic colectomy for right side colon cancer. It was suggested that proficiency in intracorporeal anastomosis may contribute to a reduction in the incidence of organ/space surgical site infections and postoperative hospital stay.
背景/目的： 由于腹腔镜线性吻合器设备的发展和腹腔镜外科医生技术的提高，腹腔镜结直肠切除术联合腔内吻合术治疗结肠癌最近越来越受欢迎。然而，腔内吻合术存在技术难点。本研究旨在明确腹腔镜外科医生掌握右半结肠癌腔内吻合技术所需的病例数。
在这项回顾性单中心研究中，选取了 2018 年 7 月至 2020 年 3 月期间由同一位腹腔镜外科医生实施腔内重叠吻合术的 51 例连续患者。从我们的数据库中获取了临床病理和围手术期数据。使用累积和 (CUSUM) 法绘制腔内吻合时间 (IAT) 的学习曲线。
CUSUM 评分随着手术例数的增加而增加，直到第 20 例 (第 1 阶段)，之后开始下降 (第 2 阶段)。与初始学习阶段 (第 1 阶段)相比，掌握阶段 (第 2 阶段)的 IAT 明显更快 (p<0.001)，器官/空间手术部位感染的发生率明显降低 (p=0.009)，术后住院时间明显缩短 (p=0.021)。
腹腔镜外科医生在腹腔镜右半结肠癌根治术中进行腔内吻合术需要 20 例才能达到熟练程度。提示熟练的腔内吻合术可能有助于降低器官/空间手术部位感染的发生率和术后住院时间。
