Tu Ching-Wei, Sun Ding-Ping, Ong Khaa-Hoo, Chen Jie-Pu, Ho Chung-Han, Lu Chih-Ying
Division of Gastroenterology & General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
Division of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
J Laparoendosc Adv Surg Tech A. 2025 Apr;35(4):286-293. doi: 10.1089/lap.2024.0393. Epub 2025 Mar 13.
With improvements in skills and evidence of safety, emergent laparoscopic cholecystectomy is routinely performed for acute cholecystitis, if indicated, at our hospital. However, resident operations are concerned with the dilemmas of training programs and patient safety. Hence, our aim was to clarify the safety and feasibility of emergency laparoscopic cholecystectomy performed by attending surgeons and residents. Our study was a retrospective review of 923 patients, who underwent laparoscopic cholecystectomy between January 2021 and June 2022 at our hospital. We excluded combined surgery, single-port methods, laparoscopic common bile duct exploration, elective surgery, and patients with Mirizzi symptoms. Of the 191 patients who underwent emergency laparoscopic cholecystectomy, 118 were operated on by residents, and 73 were operated on by attending surgeons. Patient demographics, surgical and postoperative outcomes, and length of hospital stay were compared between the groups. No significant differences were observed in sex, age, body mass index (BMI), or surgical history. Older age (60 versus 52 years) and higher BMI (26.29 versus 25.46) were observed in the attending group, and the severity was greater than that in the resident group. No significant differences were observed in the operative results, including mortality (both groups, = 0), morbidity, blood loss, or length of stay. However, the operation time was significantly shorter in the attending group obviously (86.41 versus 117.89 minutes, < .0001) significantly. Emergent laparoscopic cholecystectomy for acute cholecystectomy performed by a resident under supervision appears feasible and safe. The resident operator was associated with increased operative times, however, not complications. This study confirms that residents can also finish surgery in precisely selected cases, and the more important concept is knowing the limits of asking for help.
随着技术的进步以及安全性证据的出现，在我们医院，如果有指征，急诊腹腔镜胆囊切除术已常规用于治疗急性胆囊炎。然而，住院医师手术涉及培训项目和患者安全的两难问题。因此，我们的目的是阐明由主治医生和住院医师进行急诊腹腔镜胆囊切除术的安全性和可行性。我们的研究是对2021年1月至2022年6月在我们医院接受腹腔镜胆囊切除术的923例患者进行的回顾性分析。我们排除了联合手术、单孔手术、腹腔镜胆总管探查术、择期手术以及有Mirizzi综合征的患者。在191例行急诊腹腔镜胆囊切除术的患者中，118例由住院医师操作，73例由主治医生操作。比较了两组患者的人口统计学特征、手术及术后结果以及住院时间。两组在性别、年龄、体重指数（BMI）或手术史方面未观察到显著差异。主治医生组患者年龄较大（60岁对52岁）且BMI较高（26.29对25.46），病情严重程度高于住院医师组。在手术结果方面，包括死亡率（两组均为0）、发病率、失血量或住院时间，未观察到显著差异。然而，主治医生组的手术时间明显更短（86.41分钟对117.89分钟，P<0.0001）。在监督下由住院医师进行的急性胆囊炎急诊腹腔镜胆囊切除术似乎是可行且安全的。住院医师操作的手术时间会延长，但并发症并未增加。本研究证实，住院医师在经过精确筛选的病例中也能完成手术，更重要的是要知道何时寻求帮助。
