间歇性术中神经监测 (IONM) 对普通外科住院医师全甲状腺切除术学习曲线的影响

IF 1.2 4区 医学 Q3 SURGERY
Alessia Fassari, Alessandra Micalizzi, Giulio Lelli, Angela Gurrado, Andrea Polistena, Angelo Iossa, Francesco De Angelis, Lorenzo Martini, Giovanni Traumuller Tamagnini, Mario Testini, Giuseppe Cavallaro
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引用次数: 0

摘要

导言喉返神经(RNL)识别是甲状腺切除术的标准。术中神经监测(IONM)作为喉返神经功能评估的补充工具已被引入。本研究旨在确定 IONM 的常规使用如何影响甲状腺切除术的学习曲线(LC):A 组包括由 3 名不同住院医师实施的 150 例未使用 IONM 的甲状腺切除术,B 组包括由其他 3 名不同住院医师实施的 150 例常规使用间歇性 IONM 的手术。通过比较手术时间(OT)、LC发展过程中的稳定性以及围手术期并发症发生率来衡量LC。同样,两组之间以及独立匹配的亚组之间,在OT和并发症方面也没有明显差异,即使在比较RLN麻痹时也是如此。各组的神经直视率和 IONM 评估率相当,没有双侧 RLN 麻痹(暂时性或永久性)的报告。结论该研究表明,尽管需要对经验丰富的外科医生进行专门培训,但使用IONM甲状腺手术并不会特别影响住院医师对此类手术的学习曲线,因此即使是对受训者,也应鼓励其常规使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Intermittent Intraoperative Neuromonitoring (IONM) on the Learning Curve for Total Thyroidectomy by Residents in General Surgery
IntroductionRecurrent laryngeal nerve (RNL) identification constitutes the standard in thyroidectomy. Intraoperative nerve monitoring (IONM) has been introduced as a complementary tool for RLN functionality evaluation. The aim of this study is to establish how routine use of IONM can affect the learning curve (LC) in thyroidectomy.MethodsPatients undergoing total thyroidectomy performed by surgery residents in their learning curve course in 2 academic hospitals, were divided into 2 groups: Group A, including 150 thyroidectomies performed without IONM by 3 different residents, and Group B, including 150 procedures with routine use of intermittent IONM, by other 3 different residents. LC was measured by comparing operative time (OT), its stabilization during the development of the LC, perioperative complication rate.ResultsAs previously demonstrated, the LC was achieved after 30 procedures, in both groups, with no differences due to the use of IONM. Similarly, there were no significant differences among the 2 groups, and between subgroups independently matched, for both OT and complications, even when comparing RLN palsy. Direct nerve visualization and IONM assessment rates were comparable in all groups, and no bilateral RLN palsy (transient or permanent) were reported. No case of interrupted procedure to unilateral lobectomy, due to evidence of RLN injury, was reported.ConclusionsThe study demonstrates that the use of IONM thyroid surgery, despite requiring a specific training with experienced surgeons, does not particularly affect the learning curve of residents approaching this kind of surgery, and for this reason its routine use should be encouraged even for trainees.
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来源期刊
Surgical Innovation
Surgical Innovation 医学-外科
CiteScore
2.90
自引率
0.00%
发文量
72
审稿时长
6-12 weeks
期刊介绍: Surgical Innovation (SRI) is a peer-reviewed bi-monthly journal focusing on minimally invasive surgical techniques, new instruments such as laparoscopes and endoscopes, and new technologies. SRI prepares surgeons to think and work in "the operating room of the future" through learning new techniques, understanding and adapting to new technologies, maintaining surgical competencies, and applying surgical outcomes data to their practices. This journal is a member of the Committee on Publication Ethics (COPE).
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