Nicola de'Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chirica, Lorenzo Cobianchi, Federico Coccolini, Raul Coimbra, Christian Cotsoglou, Mathieu D'Hondt, Dimitris Damaskos, Belinda De Simone, Salomone Di Saverio, Michele Diana, Eloy Espin-Basany, Stefan Fichtner-Feigl, Paola Fugazzola, Paschalis Gavriilidis, Caroline Gronnier, Jeffry Kashuk, Andrew W Kirkpatrick, Michele Ammendola, Ewout A Kouwenhoven, Alexis Laurent, Ari Leppaniemi, Mickaël Lesurtel, Riccardo Memeo, Marco Milone, Ernest Moore, Nikolaos Pararas, Andrew Peitzmann, Patrick Pessaux, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Frederic Ris, Tyler Robison, Massimo Sartelli, Vishal G Shelat, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Ellen Van Eetvelde, Yoram Kluger, Dieter Weber, Fausto Catena
{"title":"微创急诊消化道手术培训课程:2022 年 WSES 立场文件。","authors":"Nicola de'Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chirica, Lorenzo Cobianchi, Federico Coccolini, Raul Coimbra, Christian Cotsoglou, Mathieu D'Hondt, Dimitris Damaskos, Belinda De Simone, Salomone Di Saverio, Michele Diana, Eloy Espin-Basany, Stefan Fichtner-Feigl, Paola Fugazzola, Paschalis Gavriilidis, Caroline Gronnier, Jeffry Kashuk, Andrew W Kirkpatrick, Michele Ammendola, Ewout A Kouwenhoven, Alexis Laurent, Ari Leppaniemi, Mickaël Lesurtel, Riccardo Memeo, Marco Milone, Ernest Moore, Nikolaos Pararas, Andrew Peitzmann, Patrick Pessaux, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Frederic Ris, Tyler Robison, Massimo Sartelli, Vishal G Shelat, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Ellen Van Eetvelde, Yoram Kluger, Dieter Weber, Fausto Catena","doi":"10.1186/s13017-023-00476-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.</p><p><strong>Methods: </strong>This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements.</p><p><strong>Results: </strong>Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency.</p><p><strong>Conclusions: </strong>Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. 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引用次数: 0
摘要
背景:微创手术(MIS),包括腹腔镜和机器人方法,在择期消化道手术中被广泛采用,但也有选择性地用于外科急诊。本立场文件总结了有关熟练掌握急诊微创手术的学习曲线的现有证据,并提供了五份专家意见陈述,可作为制定急诊微创手术标准化课程和培训计划的基础:本立场文件是根据世界急诊外科学会的方法编写的。一个指导委员会和一个国际专家小组参与了文献的批判性评估和共识声明的制定:结果:共选取了 13 项有关急诊 MIS 学习曲线的研究。除一项研究外,其他所有研究都考虑了腹腔镜阑尾切除术。只有一项研究报告了急诊机器人手术。在大多数研究中,根据最初外科医生的经验,平均 30 例手术(范围:20-107 例)后即可达到熟练程度。学习曲线的评估方式存在高度异质性。专家们认为,有必要进一步研究急诊 MIS 的学习曲线过程。急诊外科医生的课程应包括基于模拟、临床实践指导(监考)和外科奖学金的循序渐进的充分培训。培训结果应通过认证系统进行评估,以确保质量标准。应保持最低工作量的手术熟练程度,并不断对其进行评估。此外,培训过程应涉及整个手术团队,以促进外科医生的熟练程度:有关腹腔镜和机器人急诊手术学习过程的证据有限。结论:有关腹腔镜和机器人急诊手术学习过程的证据有限,建议的声明应被视为外科界的初步指南,同时强调进一步研究的必要性。
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper.
Background: Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.
Methods: This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements.
Results: Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency.
Conclusions: Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.
期刊介绍:
The World Journal of Emergency Surgery is an open access, peer-reviewed journal covering all facets of clinical and basic research in traumatic and non-traumatic emergency surgery and related fields. Topics include emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management, and resuscitation, among others.