Original
J Minim Invasive Surg 2002; 5(2): 109-117
Published online December 31, 2002
© The Korean Society of Endo-Laparoscopic & Robotic Surgery
복강경 담낭절제술 시 술 후 비디오 테이프를 통한 Scoring System을 이용한 Learning Curve
권국환1·김용일1·윤성현1·강중구1·조장환1,2
1국민건강보험공단 일산병원 외과, 2연세대학교 의과대학 외과학교실
Learning Curve by Scoring System of Postoperative Videotape of Laparoscopic Cholecystectomy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purposes: Technical skills of laparoscopic surgery is somewhat different from open surgery, so operators have to learn different skills. But there was no standardized format for evaluating laparoscopic skills. Thomas R Eubanks proposed an objective scoring system for laparoscopic cholecystectomy (LC). We applied this scoring system to our cases for assessing technical skills and evaluating the learning curve.
Methods: We reviewed videotapes and clinical records of 28 patients who had LC from July 1st 2000 to Dec. 31th 2000.
Results: The mean operative time (MOT) was 66.9 minutes (min.). The mean raw score was 79.1, the mean error point was 11.6 and the mean final score (MFS) was 67.5. 5 procedures (17.9%) did not successfully complete all the steps. The most frequent errors were liver injury with no bleeding (87.5%), unintentional release of gallbladder (53.6%), additional attempt at cystic duct (46.4%), spilled bile or gall stones (25.0%), slipped trocar (21.4%) in order of frequency. There was no major injury except 1 case of cystic artery tear. The longer operations above the MOT were 11 cases and its MFS was 62.9 and shorter operations were 17 cases and its MFS was 70.8. The higher cases above the MFS were 18 and its MOT was 60.1 min. and the lower group were 10 cases and its MOT was 77.2 min. But there was no statistical significance between operative time and final score. 9 cases were acute cholecystitis, its MOT was 84.2 min. and its MFS was 57.7, other 19 cases showed that its MOT was 57.7 min. and its MFS was 71.8. But there was no statistical significance of operative time and final score between acute cholecystitis and others.
Conclusion: The scoring system proposed by Eubanks seems to be a reliable tool for evaluating the technical skills and learning curve during LC, even though our results had no statistical significance. For including all steps of LC, some modifications (trocar insertion and specimen evacuation) are required.
Keywords Scoring system, Learning curve, Laparoscopic cholecystectomy
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Original
J Minim Invasive Surg 2002; 5(2): 109-117
Published online December 31, 2002
Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.
복강경 담낭절제술 시 술 후 비디오 테이프를 통한 Scoring System을 이용한 Learning Curve
권국환1·김용일1·윤성현1·강중구1·조장환1,2
1국민건강보험공단 일산병원 외과, 2연세대학교 의과대학 외과학교실
Learning Curve by Scoring System of Postoperative Videotape of Laparoscopic Cholecystectomy
Kuk-Hwan Kwon, M.D.1, Yong-Il Kim, M.D.1, Seong-Hyeon Yoon, M.D.1, Jung-Gu Kang, M.D.1, Chang-Hwan Cho, M.D.1,2
1Department of Surgery, National Health Insurance Corporation Ilsan Hospital, 2Department of Surgery, Yonsei University College of Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purposes: Technical skills of laparoscopic surgery is somewhat different from open surgery, so operators have to learn different skills. But there was no standardized format for evaluating laparoscopic skills. Thomas R Eubanks proposed an objective scoring system for laparoscopic cholecystectomy (LC). We applied this scoring system to our cases for assessing technical skills and evaluating the learning curve.
Methods: We reviewed videotapes and clinical records of 28 patients who had LC from July 1st 2000 to Dec. 31th 2000.
Results: The mean operative time (MOT) was 66.9 minutes (min.). The mean raw score was 79.1, the mean error point was 11.6 and the mean final score (MFS) was 67.5. 5 procedures (17.9%) did not successfully complete all the steps. The most frequent errors were liver injury with no bleeding (87.5%), unintentional release of gallbladder (53.6%), additional attempt at cystic duct (46.4%), spilled bile or gall stones (25.0%), slipped trocar (21.4%) in order of frequency. There was no major injury except 1 case of cystic artery tear. The longer operations above the MOT were 11 cases and its MFS was 62.9 and shorter operations were 17 cases and its MFS was 70.8. The higher cases above the MFS were 18 and its MOT was 60.1 min. and the lower group were 10 cases and its MOT was 77.2 min. But there was no statistical significance between operative time and final score. 9 cases were acute cholecystitis, its MOT was 84.2 min. and its MFS was 57.7, other 19 cases showed that its MOT was 57.7 min. and its MFS was 71.8. But there was no statistical significance of operative time and final score between acute cholecystitis and others.
Conclusion: The scoring system proposed by Eubanks seems to be a reliable tool for evaluating the technical skills and learning curve during LC, even though our results had no statistical significance. For including all steps of LC, some modifications (trocar insertion and specimen evacuation) are required.
Keywords: Scoring system, Learning curve, Laparoscopic cholecystectomy
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