腹腔镜袖状胃切除术由主治医生和受训外科医生进行的学习曲线和手术结果。

Learning Curves and Surgical Outcomes of Laparoscopic Sleeve Gastrectomy Performed by an Attending Surgeon and Trainee Surgeons.

机构信息

Department of Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.

Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.

出版信息

Asian J Endosc Surg. 2025 Jan-Dec;18(1):e13414. doi: 10.1111/ases.13414.

DOI:10.1111/ases.13414

PMID:39572907

Abstract

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a commonly performed procedure for bariatric and metabolic surgery. However, few reports exist concerning the learning curves and surgical outcomes of LSG among trainee surgeons. This study aimed to investigate the learning curves and surgical outcomes of LSG for one attending surgeon and trainee surgeons.

METHODS

In this study, 90 patients who underwent LSG were retrospectively evaluated. Surgical learning curves for the attending and the trainees were assessed via cumulative sum (CUSUM) analysis. After the attending reached the learning phase, the trainees performed LSG under the guidance of the attending. Surgical and postoperative outcomes were compared retrospectively.

RESULTS

The CUSUM plot of the attending peaked in the 16th case, began to decrease and reached a plateau in the 49th case. Therefore, we defined the attending in Phase I up to 16 LSGs (n = 16; learning phase), in phase II between 27 and 48 LSGs (n = 22; acquisition phase), and in Phase III from 49 or more LSGs (n = 29; plateau phase). The CUSUM of the trainees' operative time declined from the beginning. The median operative time was significantly shorter in the trainees than in the attending in Phase I (184 [146-266] vs. 161 [111-255], p < 0.01). %EWL was significantly better in the patients of the trainees than in those of the attending (92.4 ± 35.7 vs. 71.0 ± 28.7, p < 0.01). These results indicate that trainees could perform LSG in a stable manner.

CONCLUSION

Under the guidance of experienced surgeons, LSG can be safely performed by trainees without prolonged surgical time.

摘要

背景

腹腔镜袖状胃切除术（LSG）是一种常用于减重和代谢手术的方法。然而，关于受训外科医生进行 LSG 的学习曲线和手术结果的报告很少。本研究旨在探讨一位主治医生和受训外科医生进行 LSG 的学习曲线和手术结果。

方法

本研究回顾性评估了 90 例行 LSG 的患者。通过累积和（CUSUM）分析评估主治医生和受训外科医生的手术学习曲线。在主治医生达到学习阶段后，受训外科医生在主治医生的指导下进行 LSG。回顾性比较手术和术后结果。

结果

主治医生的 CUSUM 图在第 16 例达到峰值，开始下降并在第 49 例达到平台期。因此，我们将主治医生定义为第 I 阶段的 16 例 LSG（n=16；学习阶段）、第 II 阶段的 27 例至 48 例 LSG（n=22；获得阶段）和第 III 阶段的 49 例或更多 LSG（n=29；平台阶段）。受训外科医生的手术时间 CUSUM 从一开始就下降。第 I 阶段受训外科医生的中位手术时间明显短于主治医生（184 [146-266] vs. 161 [111-255]，p<0.01）。受训外科医生的体重减轻百分比（%EWL）明显优于主治医生（92.4±35.7 vs. 71.0±28.7，p<0.01）。这些结果表明，受训外科医生可以稳定地进行 LSG。