Botha A J, Elton C, Moore E E, Sauven P
Broomfield Hospital, Chelmsford, Essex.
Ann R Coll Surg Engl. 1995 Jul;77(4):259-62.
Minimally invasive surgery is rapidly becoming an integral part of general surgery. Many general surgeons have been trained to undertake laparoscopic cholecystectomy. It has been recommended that laparoscopic appendicectomy should be the training operation for junior surgeons. The aim of our study was to assess whether laparoscopic appendicectomy training can safely be introduced to junior surgeons in a district general hospital. During the 11 month study period, 27 laparoscopic and 38 open appendicectomies were performed. The median anaesthetic time was 80 min for laparoscopic and 52.5 min for open appendicectomies. Laparoscopic appendicectomies cost, on average, 618 pounds and open appendicectomies 770 pounds per case. The complication rate between the two procedures was equal. We therefore showed that laparoscopic appendicectomy by junior surgeons is both safe and cost-effective. Although the registrar did most of the laparoscopic appendicectomies, with resultant less operating for the SHO, laparoscopic appendicectomy provided the SHO with training in diagnostic laparoscopy and laparoscopic dissection. We conclude that basic laparoscopic training should be introduced early in surgical training, after which laparoscopic appendicectomy is a safe procedure for surgical trainees.
微创手术正迅速成为普通外科不可或缺的一部分。许多普通外科医生已接受培训以进行腹腔镜胆囊切除术。有人建议腹腔镜阑尾切除术应作为初级外科医生的培训手术。我们研究的目的是评估在地区综合医院能否安全地向初级外科医生引入腹腔镜阑尾切除术培训。在为期11个月的研究期间，共进行了27例腹腔镜阑尾切除术和38例开放性阑尾切除术。腹腔镜阑尾切除术的中位麻醉时间为80分钟，开放性阑尾切除术为52.5分钟。腹腔镜阑尾切除术平均每例花费618英镑，开放性阑尾切除术每例花费770英镑。两种手术的并发症发生率相同。因此，我们表明初级外科医生进行腹腔镜阑尾切除术既安全又具有成本效益。尽管住院医生进行了大部分腹腔镜阑尾切除术，导致实习医生的手术量减少，但腹腔镜阑尾切除术为实习医生提供了诊断性腹腔镜检查和腹腔镜解剖的培训。我们得出结论，应在外科培训早期引入基础腹腔镜培训，在此之后，腹腔镜阑尾切除术对外科实习生来说是一种安全的手术。
