Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
St. James's University Hospital, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
Surg Endosc. 2023 Nov;37(11):8227-8235. doi: 10.1007/s00464-023-10392-4. Epub 2023 Aug 31.
A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy.
Surgeons who had completed the GL training program participated in the online RedCap Registry. Patients included in the registry provided informed consent for the use of their data. Data on operative times, conversion rates, perioperative complications, length of stay, and hospital costs were collected. Fixed reference cumulative sum (CUSUM) model was used to evaluate the learning curve based on operative times and conversion rates published in the literature.
Four surgeons from three rural hospitals in North-East India participated in the registry. The data were collected over 12 months, from September 2019 to August 2020. One hundred and twenty-three participants underwent GL procedures, including 109 females (88.6%) and 14 males. GL procedures included cholecystectomy, appendicectomy, tubal ligation, ovarian cystectomy, diagnostic laparoscopy, and adhesiolysis. The mean operative time was 75.3 (42.05) minutes for all the surgeries. Conversion from GL to open surgery occurred in 11.4% of participants, with 8.9% converted to conventional laparoscopy. The main reasons for conversion were the inability to secure an operative view, lack of operating space, and adhesions. The mean length of stay was 3 (2.1) days. The complication rate was 5.7%, with one postoperative death. The CUSUM analysis for GL cholecystectomy showed a longer learning curve for operative time and few conversions. The learning curve for GL tubal ligation was relatively shorter.
Gasless laparoscopy can be safely implemented in the rural settings of Northeast India with appropriate training programs. Careful case selection is essential during the early stages of the surgical learning curve.
在印度东北部的农村地区实施了无气腹腔镜（GL）计划。为了促进安全采用，参与的农村外科医生在独立临床实践前接受了严格的培训。建立了一个在线登记处，以收集关于安全性和有效性的临床数据，并评估无气腹腔镜的初步学习曲线。
完成 GL 培训计划的外科医生参与了在线 RedCap 登记处。登记处中包含的患者提供了使用其数据的知情同意。收集了手术时间、转换率、围手术期并发症、住院时间和住院费用的数据。使用固定参考累积和（CUSUM）模型根据文献中发表的手术时间和转换率评估学习曲线。
印度东北部的三家农村医院的四名外科医生参与了该登记处。数据收集时间为 2019 年 9 月至 2020 年 8 月，共 12 个月。123 名参与者接受了 GL 手术，其中 109 名女性（88.6%）和 14 名男性。GL 手术包括胆囊切除术、阑尾切除术、输卵管结扎术、卵巢囊肿切除术、诊断性腹腔镜检查和粘连松解术。所有手术的平均手术时间为 75.3（42.05）分钟。有 11.4%的参与者从 GL 转为开放手术，其中 8.9%转为传统腹腔镜手术。转换的主要原因是无法获得手术视野、操作空间不足和粘连。平均住院时间为 3（2.1）天。并发症发生率为 5.7%，术后死亡 1 例。GL 胆囊切除术的 CUSUM 分析显示手术时间的学习曲线较长，且转换较少。GL 输卵管结扎术的学习曲线相对较短。
在印度东北部的农村地区，通过适当的培训计划，可以安全地实施无气腹腔镜手术。在手术学习曲线的早期阶段，仔细选择病例至关重要。
