결장직장 질환에서 수부보조 복강경 수술과 고식적 복강경 수술의 습득곡선 비교
Learning Curve for Laparoscopic Colorectal Surgery: Hand Assisted Laparoscopic Surgery (HALS) versus Conventional Laparoscopic Surgery (CLS)
윤해란, 이원석, 윤성현, 전호경, 이우용,
소속 상세정보
윤해란 ( Yun Hae-Ran )
성균관대학교 의과대학 삼성서울병원 외과
이원석 ( Lee Won-Suk )
성균관대학교 의과대학 삼성서울병원 외과
윤성현 ( Yun Seong-Hyeon )
성균관대학교 의과대학 삼성서울병원 외과
전호경 ( Chun Ho-Kyung )
성균관대학교 의과대학 삼성서울병원 외과
이우용 ( Lee Woo-Yong )
성균관대학교 의과대학 삼성서울병원 외과
KMID : 0356720070230030161
Abstract
Purpose: Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS fo
Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group.
Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6±34.6 minutes versus 179.1±36.5 minutes, P＜0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups.
Conclusions: In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups. J Korean Soc Coloproctol 2007;23:161-166
키워드
습득 곡선;수부 보조 복강경 수술;고식적 복강경수술
Learning curve;Hand-assisted laparoscopic surgery (HALS);Conventional laparoscopic surgery (CLS)
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