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Zentralbl Chir 2011; 136(3): 273-281
DOI: 10.1055/s-0030-1262684
Originalarbeit

© Georg Thieme Verlag KG Stuttgart ˙ New York

Lernkurve in der laparoskopischen Rektumchirurgie

Learning Curve in Laparoscopic Rectum SurgeryT. C. Böttger1 , D. Mohseni2 , J. Beardi2 , A. Rodehorst3
  • 1Euromed Clinic, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Fürth, Deutschland
  • 2Schön Klinik Neustadt, Chirurgie, Unfallchirurgie, Neustadt in Holstein, Deutschland
  • 3Capio Krankenhaus, Land Hadeln, Otterndorf, Deutschland
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Publication History

Publication Date:
28 February 2011 (online)

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Zusammenfassung

Die laparoskopische kolorektale Chirurgie hat sich seit der Erstbeschreibung 1990 zunehmend verbreitet. Im Gegensatz zu einer Vielzahl von Untersuchungen zur Lernkurve in der laparoskopischen Kolonchirurgie fehlen derartige Arbeiten zur laparoskopischen Rektumchirurgie nahezu vollstän­dig. In der vorliegenden Arbeit wird die Lernkurve eines Chirurgen in der laparoskopischen Rektumchirurgie aufgezeigt. Basierend auf den Daten einer prospektiven Beobachtungsstudie von 180 Patienten, kann festgestellt werden, dass von einem in der offenen kolorektalen Chirurgie erfahrenen Operateur, mit Anfangserfahrung in der lapa­rosko­pischen Chirurgie und nach ent­spre­chen­der Vorbereitung und gleichzeitigem ­Interesse an der ­minimalinvasiven Chirurgie ca. 35 laparoskopische Rektumresektionen und 200 laparoskopische Kolonresektionen notwendig sind, bis Selektions­rate, Operationszeit, allgemeine und chirurgische Komplikationen ein Plateau erreicht haben. Eine der operativen Erfahrung angepasste Selektion ist Voraussetzung für eine niedrige Konversions- und Komplikationsrate sowie mit der offenen Chirurgie vergleichbaren onkologischen Lang­zeitergebnissen. Die Lernkurve ist allerdings von sehr vielen Faktoren abhängig, die wir teilweise gar nicht kennen. Sie ist sicherlich interindivi­duell unterschiedlich lang. Jeder Chirurg sollte kritisch seine laparoskopische Erfahrung beur­teilen und dementsprechend selektieren. Eine Super­vision durch in der laparoskopischen kolorektalen Chirurgie erfahrene Operateure verhindert die mit der Lernkurve verbundenen Nach­teile für den Patien­ten. Die Ausbildung in der ­laparoskopischen kolorektalen Chirurgie sollte nur in Zentren mit der entsprechenden Fallzahl und Kontinui­tät der Ausbilder erfolgen. Die Bemühungen der CAMIC in der Etablierung von ­Referenz- und Kompetenzzentren sind daher nur zu unterstützen. 

Abstract

Laparoscopic colorectal surgery has become increasingly more common since first being described in a publication in 1990. Despite a multitude of studies about the learning curve in laparoscopic colon surgery, there are almost no such studies with regard to laparoscopic rectum surgery. This paper aims to describe a surgeon's learning curve with regard to laparoscopic rectum surgery. Based on data collected in a prospective observational study of 180 patients, it can be established that a surgeon experienced in open colorectal surgery, with basic experience in laparoscopic surgery, after suitable preparation and having a personal interest in minimally invasive surgery, needs to perform about 35 laparoscopic rectum resections within 200 laparoscopic colon resections until selection rate, operating time and rates of general and surgical complications reach a plateau. A selection of cases suited to a surgeon's personal level of operating experience, is a prerequisite for a low rate of conversions and complications and for oncological long-term results comparable to those achieved through open surgery. However, the learning curve is dependent on a multitude of factors that are partly unknown at this point. Its duration most certainly varies between individual surgeons. Every surgeon is required to critically evaluate his or her own laparoscopic experience and select cases accordingly. Supervision by surgeons more experienced in laparoscopic colorectal surgery prevents disadvantages for patients in the early phases of the surgeon's learning curve. Training in laparoscopic colorectal surgery should take place only in institutions with a sufficient number of cases treated and a continuity in experienced teachers. CAMIC's efforts in establishing centres of competence and reference are therefore to be commended and supported. 

Schlüsselwörter

laparoskopische Rektumchirurgie - Lernkurve - Team

Key words

laparoscopic rectum surgery - learning curve - team

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Prof. T. C. Böttger

Euromed Clinic

Europa-Allee 1

90763 Fürth

Deutschland

Phone: +49 / (0)9 11 / 9 71 40

Fax: +49 / (0)9 11 / 9 71 45 55

Email: thomasboettger@gmx.de

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