Evaluating the Effect of Surgical Skill on Outcomes for Laparoscopic Sleeve Gastrectomy A Video-based Study
Evaluating the Effect of Surgical Skill on Outcomes for Laparoscopic Sleeve Gastrectomy A Video-based Study
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DOI：
10.1097/sla.0000000000003385
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发表时间：
2021-04-01
影响因子：
9
通讯作者：
Dimick, Justin B.
中科院分区：
文献类型：
--
作者：
Varban, Oliver A.;Thumma, Jyothi R.;Dimick, Justin B.
背景：先前的研究已经证明了腹腔镜Roux-en-Y胃旁路术后手术技巧和并发症发生率之间的相关性。然而，手术技巧对类似但技术挑战性较低的手术（如袖状胃切除术（SG））的影响尚不清楚。研究方法：参与全州质量改进协作的执业减肥外科医生（n = 25）提交了一份代表性腹腔镜SG的未经编辑的去识别视频。视频是在2015年至2016年期间获得的，并由减肥外科医生使用经验证的评估手术技能的工具以盲态方式进行评级。总体评分基于5分Likert量表，5分代表“外科大师”，1分代表“实习外科医生”。“研究期间进行的病例中，风险调整后的30天并发症发生率、1年体重减轻率以及手术技术在根据技能评定的最高和最低四分位数之间进行了比较。结果：外科医生的技能评分在2.73和4.60之间变化。技能评分与30天风险调整后的总体并发症发生率无关（Pearson相关系数，0.213，P = 0.303）。然而，技能等级较高的外科医生的特定手术并发症发生率较低，包括术后梗阻（0.13% vs 0.3%，P = 0.017）、出血（0.85% vs 1.27%，P = 0.005）和再次手术（0.24% vs 0.92%，P < 0.0001）。技能排名前四分之一的外科医生的SG手术时间更快（59.0 vs 82.1分钟，P < 0.0001）以及SG和任何减肥手术的年病例量更高（224.3例/年vs 73.4例/年，P = 0.009; 244.9例/年vs 93.9例/年，P = 0.009）。在比较手术技术时，最高评级的外科医生使用支撑（83.3% vs 0%，P = 0.0041）和术中内窥镜检查（83.3% vs 0%，P = 0.0041）的可能性更高。结论：同行对腹腔镜袖状胃切除术手术技巧的评价各不相同，但对总体并发症发生率没有显著影响。评分最高的外科医生梗阻、出血和再次手术的发生率较低;然而，所有外科医生的严重发病率仍然极低。
Background: Prior studies have demonstrated a correlation between surgical skill and complication rates after laparoscopic Roux-en-Y gastric bypass. However, the impact of surgical skill on a similar but less technically challenging procedure such as sleeve gastrectomy (SG) is unknown. Methods: Practicing bariatric surgeons (n = 25) participating in a statewide quality improvement collaborative submitted an unedited deidentified video of a representative laparoscopic SG. Videos were obtained between 2015 and 2016 and were rated by bariatric surgeons in a blinded fashion using a validated instrument that assesses surgical skill. Overall scores were based on a 5-point Likert scale with 5 representing a "master surgeon" and 1 representing a "surgeon-in-training." Risk-adjusted 30-day complication rates, 1-year weight loss among cases performed during the study period, and operative technique were compared between surgeons rated in the top and bottom quartiles according to skill. Results: Surgeon ratings for skill varied between 2.73 and 4.60. Ratings for skill did not correlate with overall 30-day risk-adjusted complication rates (Pearson correlation coefficient, 0.213, P = 0.303). However, surgeons with higher skill ratings had lower rates of specific surgical complications, including postoperative obstruction (0.13% vs 0.3%, P = 0.017), hemorrhage (0.85% vs 1.27%, P = 0.005), and reoperation (0.24% vs 0.92%, P < 0.0001). Surgeons ranked in the top quartile for skill had faster operating times for SG (59.0 vs 82.1 min, P < 0.0001) and higher annual case volumes for both SG and any bariatric procedure (224.3 cases/yr vs 73.4 cases/yr, P = 0.009 and 244.9 cases/yr and 93.9 cases/yr, P = 0.009) when compared with surgeons in the bottom quartile. When comparing operative technique, top rated surgeons were noted to have a higher likelihood of using buttressing (83.3% vs 0%, P = 0.0041) and intraoperative endoscopy (83.3% vs 0%, P = 0.0041). Conclusions: Peer ratings for surgical skill varied for laparoscopic sleeve gastrectomy but did not have a significant impact on overall complication rates. Top rated surgeons had lower rates of obstruction, hemorrhage, and reoperation; however, severe morbidity remained extremely low among all surgeons.