手術ビデオから記録した手術操作時間による腹腔鏡下大腸切除術定型化の評価

Evaluation of stylized laparoscopic colon resection by operation time recorded from surgical videos

◆要旨：【目的と方法】腹腔鏡下大腸切除術を未修練の外科医2名が執刀した，原発性大腸癌に対しての腹腔鏡下S状結腸切除術23例，腹腔鏡下高位前方切除術7例の連続30例に対し，指導医の手術参加の有無，および手術ビデオを見ながらパート（準備，腹部操作，骨盤操作）別に癒着剝離などの時間を除いた腹腔鏡操作時間を記録し，前期と後期の15例ずつで比較した．【結果】手術時間（前期：後期）は219分：193分，指導医の手術参加は87％：7％といずれも差を認めた．手術操作時間はすべてのパートで右肩下がりの順調なlearning curveを示した．【結論】当院の腹腔鏡下大腸切除術は良好なlearning curveを示した．これは手術の定型化によるものと考えられた．

The purpose of this study was to evaluate the learning curve and the quality of standardized laparoscopic colectomy. We selected 30 consecutive patients（23 cases of laparoscopic sigmoidectomy and 7 cases of laparoscopic high anterior resection） who underwent laparoscopic surgery, performed by two surgeons with no previous experience of laparoscopic colectomy. We compared the participation of supervising surgeon and the “Video time” （i.e., surgical time required to complete various laparoscopic procedures, reviewed and taken from the recorded video） s between the first 15 cases and the last 15 cases. The patient's characteristic showed no significant difference between the two periods. Operation time was 219 minutes for the first 15 cases and193 minutes for the last 15 cases; the participation rates of supervising surgeon was 87％ and 7％, respectively. Video time for each group showed declining curve, indicating a good learning curve for laparoscopic colectomy in our institusion, most probably due to standardization of laparoscopic colectomy.