Trainee competence in thoracoscopic esophagectomy in the prone position: evaluation using cumulative sum techniques
Trainee competence in thoracoscopic esophagectomy in the prone position: evaluation using cumulative sum techniques
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DOI：
10.1007/s00423-016-1484-2
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发表时间：
2016-09-01
影响因子：
2.3
通讯作者：
Kakeji, Yoshihiro
中科院分区：
文献类型：
--
作者：
Oshikiri, Taro;Yasuda, Takashi;Kakeji, Yoshihiro
微创食管切除术（MIE）的发病率低于开放方法。特别是，俯卧位胸腔镜食管切除术（TEP）已在世界范围内进行。本研究采用累积和控制图（Cumulative sum control chart，简称CSUM）方法，旨在确认学习既定标准的实习外科医生是否会在较短的学习曲线下熟练掌握TEP，而不是指导外科医生。根据胸外科手术的手术时间（OT）定义了他的学习曲线，并使用CARIUM方法对学习曲线进行了评价，并对短期结局进行了评估。B医生对22例患者进行了TEP，并与A医生第1周期的结果进行比较。根据ATEUM图，A医生100例胸外科手术OT的峰值出现在第44例。对于外科医生A的前22例病例（第1阶段），无法确认胸外科手术OT的峰值点，并且图形正在扩展，在XNUUM图表上飙升。B医生22例经验的胸外科手术操作图清楚地表明，胸外科手术OT的峰值点出现在第17例。在第1阶段，外科医生B的喉返神经麻痹发生率（9%）显著低于外科医生A（36%）（p = 0.0266）。实习外科医生有可能在相对较短的时间内使用指导外科医生开发的标准化程序获得执行TEP所需的基本技能。在最初的一系列程序中，通过评估OT定义的学习曲线，评估受训者的能力时，CNOUM方法应该是有用的。
Minimally invasive esophagectomy (MIE) has less morbidity than the open approach. In particular, thoracoscopic esophagectomy in the prone position (TEP) has been performed worldwide. Using the cumulative sum control chart (CUSUM) method, this study aimed to confirm whether a trainee surgeon who learned established standards would become skilled in TEP with a shorter learning curve than that of the mentoring surgeon.Surgeon A performed TEP in 100 patients; the first 22 patients comprised period 1. His learning curve, defined based on the operation time (OT) of the thoracic procedure, was evaluated using the CUSUM method, and short-term outcomes were assessed. Another 22 patients underwent TEP performed by surgeon B, with outcomes compared to those of surgeon A's period 1.Using the CUSUM chart, the peak point of the thoracic procedure OT occurred at the 44th case in surgeon A's experience of 100 cases. With surgeon A's first 22 cases (period 1), the peak point of the thoracic procedure OT could not be confirmed and graph is expanding soaring at CUSUM chart. The CUSUM chart of surgeon B's experience of 22 cases clearly indicated that the peak point of the thoracic procedure OT occurred at the 17th case. The rate of recurrent laryngeal nerve palsy for surgeon B (9 %) was significantly lower than for surgeon A in period 1 (36 %) (p = 0.0266).There is some possibility for a trainee surgeon to attain the required basic skills to perform TEP in a relatively short period of time using a standardized procedure developed by a mentoring surgeon. The CUSUM method should be useful in evaluating trainee competence during an initial series of procedures, by assessing the learning curve defined by OT.