Elder S, Kunin J, Chouri H, Sabo E, Matter I, Nash E, Schein M
Department of Surgery, Bnai Zion Medical Center, Haifa, Israel.
Surg Laparosc Endosc. 1996 Jun;6(3):218-20.
In a prospective audit of our first 213 laparoscopic cholecystectomies (LC), we compared the results obtained by qualified surgeons to those obtained by residents. The first group started performing LC after undergoing formal laboratory laparoscopic courses. The second group was introduced to LC by standard attending-resident teaching in the operating room. In all, 137 LC wer performed by qualified surgeons and 76 by residents. Patients' clinical and laboratory characteristics were not significantly different in the two groups. The conversion rate to laparotomy (11.5% and 12.5%), mean duration of surgery (88 and 83 min), iatrogenic perforation of the gallbladder (16% and 18.5%), "lost stones" (7% and 4%), use of drains (12% and 13%), and extension of the umbilical port incision (about 30% in both groups) were similar in the two groups. The incidence of biliary (3% and 4%) and infectious (3.5% and 4%) complications was equivalent in both groups. We conclude that with the traditional attending-resident approach to surgical education, residents safely and quickly acquire the necessary skills to perform LC without jeopardizing the safety of patients.
在对我们最初的213例腹腔镜胆囊切除术（LC）进行的前瞻性审计中，我们将合格外科医生的手术结果与住院医师的手术结果进行了比较。第一组在参加正规的腹腔镜实验室课程后开始进行LC手术。第二组通过手术室标准的带教-住院医师教学方式接触LC手术。合格外科医生共进行了137例LC手术，住院医师进行了76例。两组患者的临床和实验室特征无显著差异。两组的开腹手术转化率（分别为11.5%和12.5%）、平均手术时长（分别为88分钟和83分钟）、胆囊医源性穿孔率（分别为16%和18.5%）、“结石残留”率（分别为7%和4%）、引流管使用率（分别为12%和13%）以及脐部切口延长率（两组均约为30%）相似。两组的胆系并发症发生率（分别为3%和4%）和感染并发症发生率（分别为3.5%和4%）相当。我们得出结论，采用传统的带教-住院医师手术教学方法，住院医师能够安全、快速地掌握进行LC手术所需的技能，且不会危及患者安全。
