Kakiuchi Yoshihiko, Kuroda Shinji, Yoshida Yusuke, Kanaya Nobuhiko, Kashima Hajime, Kikuchi Satoru, Kagawa Shunsuke, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama City, Okayama, 700-8558, Japan.
Langenbecks Arch Surg. 2024 Dec 28;410(1):20. doi: 10.1007/s00423-024-03593-5.
Gastric cancer (GC) remains a major malignancy. Robotic gastrectomy (RG) has gained popularity due to various advantages. Despite those advantages, many hospitals lack the necessary equipment for RG and are still performing laparoscopic gastrectomy (LG) due to its established minimal invasiveness and safety.
This study assessed the effectiveness of the "Double-Surgeon Technique" (DST) for improving surgical education and proficiency with LG. The DST involves both a console-side surgeon and a patient-side surgeon working actively in RG, enhancing the skill acquisition needed for LG and potentially reducing surgical time. Assessment of this method was performed by surgical time, and cases were divided into three groups: first half (Phase 1: P1) and second half (P2) before the introduction of DST, and after the introduction of DST (P3).
Two surgical trainees were trained using the DST. The learning curve in both reached a plateau in P2, but descended again in P3. For one trainee, surgical time for P3 was significantly reduced compared to P1 (p = 0.001) and P2 (p = 0.0027) despite the intervals between laparoscopic distal gastrectomy as the main surgeon in P3 being significantly longer than in P2 (p = 0.0094). Other surgical results in both trainees did not differ significantly. Further, no difference in induction phase results of RG were evident between surgeons and trainees with or without DST experience.
Surgical education using the DST could be effective in the current context of the need for RG and LG.
胃癌仍是一种主要的恶性肿瘤。机器人胃癌切除术(RG)因其诸多优势而受到欢迎。尽管有这些优势,但许多医院缺乏开展RG所需的必要设备,由于腹腔镜胃癌切除术(LG)已确立的微创性和安全性,仍在进行该手术。
本研究评估了“双术者技术”(DST)对提高LG手术教学效果和熟练度的有效性。DST包括一名控制台侧术者和一名患者侧术者在RG中积极协作,增强LG所需的技能习得,并可能缩短手术时间。通过手术时间对该方法进行评估,病例分为三组:引入DST前的前半段(阶段1:P1)和后半段(P2),以及引入DST后(P3)。
两名外科住院医师接受了DST培训。两人的学习曲线在P2达到平台期,但在P3又有所下降。对于一名住院医师,尽管P3中作为主刀医师进行腹腔镜远端胃癌切除术的间隔时间明显长于P2(p = 0.0094),但P3的手术时间与P1(p = 0.001)和P2(p = 0.0027)相比显著缩短。两名住院医师的其他手术结果无显著差异。此外,有无DST经验的术者和住院医师在RG诱导期结果方面无明显差异。
在当前对RG和LG有需求的背景下,使用DST进行手术教学可能是有效的。