腹腔鏡下鼠径ヘルニア修復術における執刀開始初期の症例数と手術成績の関連

Relation between the number of surgeries and surgical outcomes in the initial phase of laparoscopic inguinal hernia repair

◆要旨：当院では2013年にTAPP（transabdominal preperitoneal repair）を導入し，手術件数は増加している．今回，専攻医教育の観点からTAPPの手術時間，短期成績の調査を目的とした．2016年4月から2020年1月までに，専攻医7名のおのおのが執刀したTAPP1例目から10例目を初期群，11例目から20例目を後期群とし，初発・片側鼠径部ヘルニア症例95例の手術時間，術後在院日数，パス逸脱症例数，術後合併症を検討した．総手術時間中央値は初期群123分，後期群84分であり有意差を認めた（p＜0.01）．術後在院日数，パス逸脱症例数，術後合併症に差は認めなかった．専攻医執刀初期では指導医が安全で慎重な操作を指導，教育することを第一としているため時間がかかったと考えられる．それでも執刀数が増えると，手術時間が短縮される傾向にあった．

　Since2013, there has been an increase in the number of TAPPs（transabdominal preperitoneal repairs）performed at our hospital. This study aimed to evaluate the surgical time and the short-term results of TAPP, from the v

iewpoint of senior resident education. From April2016 to January2020, there were a total of seven senior residents. The first ten TAPPs performed by each senior resident were included in the early group, while the next ten repairs were included in the late group. Only initial and unilateral inguinal hernia cases were included in our study. The surgical time, length of postoperative hospital stay, and post-operative complications were examined. No statistically significant difference in median total operation time（123 minutes in the early group and 84 minutes in the late group［p＜0.01］）was observed. Furthermore, no statistically significant difference in the length of postoperative hospital stay and post-operative complications were observed. It was speculated that a longer surgical time was observed in the early group due to the guidance of attending doctors in the first few surgeries of senior residents. In contrast, the increasing number of TAPPs performed resulted in decreased surgical time in the late group.