Friedman R L, Pace B W
Department of Surgery, Beth Israel Medical Center, New York, NY 10003, USA.
Surg Endosc. 1996 Jan;10(1):26-8. doi: 10.1007/s004649910005.
Resident education in laparoscopic cholecystectomy (LC) was studied in a retrospective analysis of consecutive cases performed at two academic institutions with different educational approaches.
Each procedure was performed by a resident as operating surgeon under the direct guidance of one of a small, constant group of LC-certified attendings acting as first assistant. In group I (n = 48), residents acquired LC skills by graded exposure and surgical responsibility similar to their training in other general surgical procedures. In group II (n = 48) residents were additionally certified via an intensive course (including didactic and animal model experience) prior to assuming responsibility as surgeon.
Results were similar in each group. No technical errors were identified. Blood transfusion was not required related to surgery. Conversion to an open procedure occurred in 10% and 8% in groups I and II, respectively. The rate of complications was 4% for group I and 8% for group II. A longer operating time was noted in group I and may be attributed to nonoperative reasons.
Education in LC via graded experience throughout residency achieves results similar to that found with the addition of an intensive course. This additional training may not be necessary for surgical residents.
通过对在两所采用不同教育方法的学术机构连续开展的病例进行回顾性分析，研究住院医师在腹腔镜胆囊切除术（LC）方面的教育情况。
每例手术均由住院医师担任主刀医生，在一小群固定的、具备LC资质的主治医生之一作为第一助手的直接指导下进行。在第一组（n = 48）中，住院医师通过逐步接触和承担手术责任来获得LC技能，这与他们在其他普通外科手术中的培训方式类似。在第二组（n = 48）中，住院医师在担任主刀医生之前，还通过强化课程（包括理论教学和动物模型经验）获得了认证。
两组结果相似。未发现技术错误。手术未导致输血情况。第一组和第二组中转开腹手术的发生率分别为10%和8%。第一组的并发症发生率为4%，第二组为8%。第一组的手术时间较长，可能归因于非手术原因。
在整个住院医师培训期间通过逐步积累经验进行LC教育，其效果与增加强化课程的效果相似。对于外科住院医师而言，这种额外培训可能并非必要。
