Windsor J A, Vokes D E
Centre for Minimally Invasive Surgery, University Department of Surgery, Auckland Hospital, New Zealand.
Aust N Z J Surg. 1994 Feb;64(2):81-7. doi: 10.1111/j.1445-2197.1994.tb02148.x.
The clinical and economic impact of minimally invasive surgery in New Zealand, especially laparoscopic cholecystectomy, has been profound but uncharted. A postal questionnaire was sent to all general surgeons in New Zealand (n = 214), in order to document the current levels of experience, adequacy of training, levels of equipment and sources of funding. In the case of laparoscopic cholecystectomy, further details were obtained relating to operative technique, complication rates and approaches to the management of choledocholithiasis. The response rate was 71%. From 27 centres, 71 of 106 active general surgeons were performing minimally invasive surgery. Of the 34 different procedures audited, cholecystectomy (3056), herniorrhaphy (178), and appendicectomy (141) were performed most often. Primary funding came from Area Health Boards (71%) and private hospital funds (25%) with 4% coming from other sources. Ten different camera/insufflator systems were used. Training was perceived to be adequate by the majority of surgeons (89%), although seven surgeons had received no specific training. Laparoscopic cholecystectomy technique included: prophylactic antibiotics (89% of surgeons), patients supine (80%), wound infiltration (80%), routine use of diathermy within triangle of Calot (36%) and a routine peritoneal drain (13%). Routine operative cholangiography was used rarely (7%) and 72% of surgeons had deliberately changed their policy with respect to its use. Twenty-two cases of laparoscopic biliary injury were identified by the survey, none of whom had operative cholangiography. The conversion rate was 13% for acute and 4% for elective laparoscopic cholecystectomy. This survey indicated the broad scope of minimally invasive surgery that is being undertaken, and highlights potentially important variations in surgical practice.
在新西兰，微创手术，尤其是腹腔镜胆囊切除术所产生的临床和经济影响意义深远却尚不明确。我们向新西兰所有普通外科医生（共214名）发送了一份邮政调查问卷，以记录当前的经验水平、培训的充分性、设备水平和资金来源。对于腹腔镜胆囊切除术，我们还获取了有关手术技术、并发症发生率以及胆总管结石处理方法的更多细节。回复率为71%。在27个中心，106名活跃的普通外科医生中有71名在进行微创手术。在所审核的34种不同手术中，胆囊切除术（3056例）、疝修补术（178例）和阑尾切除术（141例）最为常见。主要资金来源为地区卫生委员会（71%）和私立医院资金（25%），4%来自其他来源。使用了10种不同的摄像/气腹系统。大多数外科医生（89%）认为培训是充分的，尽管有7名外科医生未接受过专门培训。腹腔镜胆囊切除术技术包括：预防性使用抗生素（89%的外科医生）、患者仰卧位（80%）、伤口浸润（80%）、在胆囊三角内常规使用电刀（36%）以及常规放置腹腔引流管（13%）。很少使用常规术中胆管造影（7%），72%的外科医生已特意改变了其使用策略。通过调查发现了22例腹腔镜胆管损伤病例，其中无一例进行术中胆管造影。急性腹腔镜胆囊切除术的中转率为13%，择期手术为4%。这项调查表明了正在开展的微创手术的广泛范围，并突出了手术实践中潜在的重要差异。
