背景:主要目标是解决全球外科护理服务的差距,东方外科医学院,中央,南部非洲(COSECSA)培训外科医生。虽然足够的手术经验对于手术训练至关重要,COSECSA训练中微创技术的使用程度仍未得到充分研究。
方法:我们从2015年1月1日至2020年12月31日对COSECSA普外科学员的手术病例日志进行了广泛审查,重点是微创外科手术的利用。我们的主要目标是确定腹腔镜手术的患病率,并将其与开放手术进行比较。我们分析了腹腔镜病例在胆囊切除术等常见适应症中的分布,阑尾炎,和疝气手术。此外,我们研究了受训者自主权的影响,国家发展指数,和医院类型对腹腔镜检查的利用。
结果:在68,659例病例中,只有616例(0.9%)是腹腔镜手术.值得注意的是,在英国等国家的受训者外部轮换期间进行了34例,德国,和印度。在非洲记录的582例腹腔镜病例中,胆囊和阑尾病理最为常见。腹腔镜胆囊切除术占29%(975例中的276例),腹腔镜阑尾切除术占3%(2548例中的76例),腹腔镜疝修补术占0.5%(5620例中有26例)。受训者自我报告说,腹腔镜手术的自主性(22.5%)低于开腹手术(61.5%)。与低收入国家(0.5%)相比,腹腔镜检查的使用在中上收入国家(2.7%)和中低收入国家(0.8%)更为普遍(p<0.001)。私立(1.6%)和基于信仰的医院(1.5%)的腹腔镜检查利用率高于公立医院(0.5%)(p<0.001)。
结论:该研究强调了ECSA地区微创技术在外科训练中的利用率相对较低。腹腔镜病例仍然是少数,根据具体诊断观察到的变化。研究结果表明,需要加强对微创手术的接触,以确保全面的培训和对这些技术的熟练程度。
BACKGROUND: With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied.
METHODS: We conducted an extensive review of COSECSA general surgery trainees\' operative
case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization.
RESULTS: Among 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001).
CONCLUSIONS: The study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques.