{"title":"急诊腹腔镜胆囊切除术治疗急性胆囊炎的住院医师与主治医师的疗效比较:一项单一医疗中心的回顾性研究","authors":"Ching-Wei Tu, Ding-Ping Sun, Khaa-Hoo Ong, Jie-Pu Chen, Chung-Han Ho, Chih-Ying Lu","doi":"10.1089/lap.2024.0393","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Background:</i></b> With improvements in skills and evidence of safety, emergent laparoscopic cholecystectomy is routinely performed for acute cholecystitis, if indicated, at our hospital. However, resident operations are concerned with the dilemmas of training programs and patient safety. Hence, our aim was to clarify the safety and feasibility of emergency laparoscopic cholecystectomy performed by attending surgeons and residents. <b><i>Materials and Methods:</i></b> Our study was a retrospective review of 923 patients, who underwent laparoscopic cholecystectomy between January 2021 and June 2022 at our hospital. We excluded combined surgery, single-port methods, laparoscopic common bile duct exploration, elective surgery, and patients with Mirizzi symptoms. Of the 191 patients who underwent emergency laparoscopic cholecystectomy, 118 were operated on by residents, and 73 were operated on by attending surgeons. Patient demographics, surgical and postoperative outcomes, and length of hospital stay were compared between the groups. <b><i>Results:</i></b> No significant differences were observed in sex, age, body mass index (BMI), or surgical history. Older age (60 versus 52 years) and higher BMI (26.29 versus 25.46) were observed in the attending group, and the severity was greater than that in the resident group. No significant differences were observed in the operative results, including mortality (both groups, <i>n</i> = 0), morbidity, blood loss, or length of stay. However, the operation time was significantly shorter in the attending group obviously (86.41 versus 117.89 minutes, <i>P</i> < .0001) significantly. <b><i>Conclusion:</i></b> Emergent laparoscopic cholecystectomy for acute cholecystectomy performed by a resident under supervision appears feasible and safe. The resident operator was associated with increased operative times, however, not complications. This study confirms that residents can also finish surgery in precisely selected cases, and the more important concept is knowing the limits of asking for help.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":"286-293"},"PeriodicalIF":1.1000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of Surgical Outcomes of Emergent Laparoscopic Cholecystectomy for Acute Cholecystitis Between Attending Surgeons and Residents: A Retrospective Study in Single Medical Center.\",\"authors\":\"Ching-Wei Tu, Ding-Ping Sun, Khaa-Hoo Ong, Jie-Pu Chen, Chung-Han Ho, Chih-Ying Lu\",\"doi\":\"10.1089/lap.2024.0393\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Background:</i></b> With improvements in skills and evidence of safety, emergent laparoscopic cholecystectomy is routinely performed for acute cholecystitis, if indicated, at our hospital. However, resident operations are concerned with the dilemmas of training programs and patient safety. Hence, our aim was to clarify the safety and feasibility of emergency laparoscopic cholecystectomy performed by attending surgeons and residents. <b><i>Materials and Methods:</i></b> Our study was a retrospective review of 923 patients, who underwent laparoscopic cholecystectomy between January 2021 and June 2022 at our hospital. We excluded combined surgery, single-port methods, laparoscopic common bile duct exploration, elective surgery, and patients with Mirizzi symptoms. Of the 191 patients who underwent emergency laparoscopic cholecystectomy, 118 were operated on by residents, and 73 were operated on by attending surgeons. Patient demographics, surgical and postoperative outcomes, and length of hospital stay were compared between the groups. <b><i>Results:</i></b> No significant differences were observed in sex, age, body mass index (BMI), or surgical history. Older age (60 versus 52 years) and higher BMI (26.29 versus 25.46) were observed in the attending group, and the severity was greater than that in the resident group. No significant differences were observed in the operative results, including mortality (both groups, <i>n</i> = 0), morbidity, blood loss, or length of stay. However, the operation time was significantly shorter in the attending group obviously (86.41 versus 117.89 minutes, <i>P</i> < .0001) significantly. <b><i>Conclusion:</i></b> Emergent laparoscopic cholecystectomy for acute cholecystectomy performed by a resident under supervision appears feasible and safe. The resident operator was associated with increased operative times, however, not complications. 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引用次数: 0
摘要
背景:随着技术的提高和安全性的证据,急诊腹腔镜胆囊切除术是急性胆囊炎的常规手术,如果有指征,在我院。然而,住院医师手术涉及培训计划和患者安全的困境。因此,我们的目的是阐明急诊腹腔镜胆囊切除术由主治医生和住院医师实施的安全性和可行性。材料和方法:我们的研究是对2021年1月至2022年6月在我院行腹腔镜胆囊切除术的923例患者的回顾性分析。我们排除了联合手术、单孔方法、腹腔镜胆总管探查、择期手术和有Mirizzi症状的患者。191例急诊腹腔镜胆囊切除术患者中,118例由住院医师实施手术,73例由主治医师实施手术。比较两组患者的人口统计、手术和术后结果以及住院时间。结果:在性别、年龄、体重指数(BMI)或手术史方面没有观察到显著差异。就诊组患者年龄较大(60岁vs 52岁),BMI较高(26.29 vs 25.46),且严重程度大于住院组。手术结果无显著差异,包括死亡率(两组,n = 0)、发病率、出血量或住院时间。而主治组手术时间明显缩短(86.41 min vs . 117.89 min, P < 0.0001)。结论:急诊腹腔镜胆囊切除术在住院医师监护下进行急性胆囊切除术是可行和安全的。然而,住院操作人员与手术时间增加有关,而不是并发症。这项研究证实,住院医生也可以在精确选择的病例中完成手术,更重要的概念是了解寻求帮助的限度。
Comparison of Surgical Outcomes of Emergent Laparoscopic Cholecystectomy for Acute Cholecystitis Between Attending Surgeons and Residents: A Retrospective Study in Single Medical Center.
Background: With improvements in skills and evidence of safety, emergent laparoscopic cholecystectomy is routinely performed for acute cholecystitis, if indicated, at our hospital. However, resident operations are concerned with the dilemmas of training programs and patient safety. Hence, our aim was to clarify the safety and feasibility of emergency laparoscopic cholecystectomy performed by attending surgeons and residents. Materials and Methods: Our study was a retrospective review of 923 patients, who underwent laparoscopic cholecystectomy between January 2021 and June 2022 at our hospital. We excluded combined surgery, single-port methods, laparoscopic common bile duct exploration, elective surgery, and patients with Mirizzi symptoms. Of the 191 patients who underwent emergency laparoscopic cholecystectomy, 118 were operated on by residents, and 73 were operated on by attending surgeons. Patient demographics, surgical and postoperative outcomes, and length of hospital stay were compared between the groups. Results: No significant differences were observed in sex, age, body mass index (BMI), or surgical history. Older age (60 versus 52 years) and higher BMI (26.29 versus 25.46) were observed in the attending group, and the severity was greater than that in the resident group. No significant differences were observed in the operative results, including mortality (both groups, n = 0), morbidity, blood loss, or length of stay. However, the operation time was significantly shorter in the attending group obviously (86.41 versus 117.89 minutes, P < .0001) significantly. Conclusion: Emergent laparoscopic cholecystectomy for acute cholecystectomy performed by a resident under supervision appears feasible and safe. The resident operator was associated with increased operative times, however, not complications. This study confirms that residents can also finish surgery in precisely selected cases, and the more important concept is knowing the limits of asking for help.
期刊介绍:
Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.