Wang Tao, Xiao Le, Lu Peng, Wen Chong, Zhang Shu-Ting, Luo Hao
General Hospital of Western Theater Command, General Surgery Center, Chengdu, China.
Department of hepatobiliary Surgery, Hainan Hospital of PLA General Hospital, Sanya, China.
J Laparoendosc Adv Surg Tech A. 2024 Dec;34(12):1056-1063. doi: 10.1089/lap.2024.0056. Epub 2024 Sep 18.
The most common therapy for gallstones is laparoscopic cholecystectomy (LC). How to help young residents avoid bile duct injuries (BDI) during surgery and grasp LC seems to be a paradox. We retrospectively reviewed 145 cases of LC operated by two residents under indocyanine green (ICG)-guided mode or normal LC procedures to illustrate the role of ICG mode in boosting the LC learning curve. The clinic data were analyzed by logistic regression, receiver operator curve tests, Cumulative Sum (CUSUM), and Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis. The operation failure rate is similar. However, operation time under ICG mode is shorter than that under normal mode. The peak at the 49 case represented the normal resident's complete mastery of the surgery, while the peak point of ICG mode appeared at the 36 case in the fitting curve. The most significant cumulative risk (peak point) of operation failure of LC was at the 35 case in ICG LC mode, while it appeared in the 49 in normal LC mode. Owing to the advantage of real-time imaging and the stable success rate of cholangiography, ICG-guided LC helps residents shorten the operation time, boost the learning curve, and manage to control the operation failure rate.
胆结石最常见的治疗方法是腹腔镜胆囊切除术（LC）。如何帮助年轻住院医师在手术中避免胆管损伤（BDI）并掌握LC似乎是一个难题。我们回顾性分析了145例由两名住院医师在吲哚菁绿（ICG）引导模式或常规LC手术方式下进行的LC手术病例，以说明ICG模式在促进LC学习曲线方面的作用。通过逻辑回归、受试者工作特征曲线测试、累积和（CUSUM）以及风险调整累积和（RA-CUSUM）分析对临床数据进行了分析。手术失败率相似。然而，ICG模式下的手术时间比常规模式下的短。拟合曲线中，第49例代表常规住院医师完全掌握手术，而ICG模式的峰值点出现在第36例。ICG引导下LC手术失败的最显著累积风险（峰值点）出现在第35例，而常规LC模式下出现在第49例。由于具有实时成像优势和胆管造影稳定成功率，ICG引导下的LC有助于住院医师缩短手术时间、促进学习曲线并控制手术失败率。
