超音波白内障手術研修の目標設定のための各手術操作時間の検討

Time analysis of each step of cataract surgery as preliminary to improve the curriculum for residents

要約　目的：白内障手術の各段階での時間を測定し，研修医に対する手術の習熟目標を設定すること。対象と方法：過去2年間に合併症なしに白内障手術が行われた40眼を対象とした。20眼については7年の手術経験がある1名の標準術者，他の20眼については経験年数が1～2年の2名の研修中の術者により行われた。全手術を撮影記録し，白内障手術を9段階に区切り，その各段階に必要とした時間を測定した。結果：標準術者の全手術時間は16.3±2.3分であり，研修中の術者のそれは27.5±4.6分と有意に長かった（p＜0.001）。標準術者は超音波乳化吸引で最も時間を要し，症例毎の時間変動が大きかった。研修中の術者は前囊切開と皮質吸引でも時間を要し，変動が大きかった。眼内レンズ挿入時間は両者間で同じであった。結論：白内障手術の各段階の時間とばらつきを計測することで，手術訓練の問題点を明確にし手術の質を向上できる。

Abstract.　Purpose：To improve the curriculum for resident surgeons by measuring the time needed for each step of cataract surgery. Object and Method：This study was made on 40 cases that received uneventful cataract surgery during the past 2 years. Twenty eyes were operated on by an experienced surgeon with 7 years' training. The other 20 eyes were operated on by 2 residents during the second year of training. All the surgical processes were recorded on an electronic device. The record was analyzed as to the time needed for each of 9 steps of surgery. Results：The duration of surgery by the experienced surgeon averaged 16.3±2.3 minutes. That by residents averaged 27.5±4.6 minutes. The difference was significant（p＜0.001）. The experienced surgeon spent the longest and varying time for phacoemulsification-aspiration. The residents spent,additionally,long and varying time for capsulorrhexis and aspiration of cortex. There was no difference between the two groups as to the time needed for intraocular lens implantation. Conclusion：Time analysis of each step of cataract surgery may contribute to improved program for surgeons in training.