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首页> 外文期刊>Surgical Endoscopy >Transition from open to laparoscopic adrenalectomy The need for advanced training.
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Transition from open to laparoscopic adrenalectomy The need for advanced training.

机译：从开放式转为腹腔镜肾上腺切除术需要高级培训。

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Background: We sought to determine the learning curve for laparoscopic adrenalectomy (LA), current use of the procedure, and if indications for adrenalectomy had changed in the past decade. Methods: A retrospective chart review was performed for all adrenalectomies after 1990. Practicing community surgeons in Oregon were mailed a questionnaire. Results: Seventy-five LAs were performed at the Oregon Health and Sciences University and Portland VA Medical Center. Average operating room (OR) time was 161 min and average estimated blood loss (EBL) was 84 ml. There were four complications and two conversions. Comparing the first 20 to the last 20 patients, OR times were 154 vs 159 min (not significant), and EBL was 102 vs 47 ml ( p < 0.05). There were two vs one complications ( p > 0.05) and one conversion each. Most residents completed less than two procedures during training, and community surgeons performed none during training. Of 17 currently performing LA, 14 had postresidency training. Open technique was used more often for hormonal ablation and malignancy. Conclusion: Operative time and complications do not decrease with experience, but EBL does. Few, if any, residents acquire enough experience to perform LA in practice. The procedure is performed laparoscopically more often for benign disease.
机译：背景：我们试图确定腹腔镜肾上腺切除术（LA）的学习曲线，当前使用的程序以及过去十年中肾上腺切除术的适应症是否发生了变化。方法：对1990年以后所有肾上腺切除术进行回顾性图表审查。俄勒冈州的一名社区外科医生被邮寄了一份问卷。结果：在俄勒冈州健康与科学大学和波特兰VA医疗中心进行了75例LA。平均手术室（OR）时间为161分钟，平均估计失血量（EBL）为84毫升。有四个并发症和两个转换。比较前20例和后20例患者的OR时间为154 vs 159分钟（不显着），EBL为102 vs 47 ml（p <0.05）。有两种并发症（一种）（p> 0.05），一种转化。大多数居民在培训期间完成的程序少于两次，而社区外科医生在培训期间没有执行任何操作。在目前执行的17个洛杉矶中，有14个接受了居住后培训。开放技术更常用于激素消融和恶性肿瘤。结论：手术时间和并发症不会随经验而减少，但EBL会减少。几乎没有居民获得足够的经验来实践LA。对于良性疾病，该手术通常在腹腔镜下进行。

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