Обучение технике лапароскопической простатэктомии

3.3. Обучение технике лапароскопической простатэктомии

Успех в освоении лапароскопической простатэктомии, главным образом, стал возможен благодаря внедрению программ обучения [18,24,100,101], использующих несколько обучающих модулей, которые включают:

Практические курсы

Курсы на трупном материале

Живые демонстрации

Клиническое обучение

Преподаватель и наставник

Самый важный шаг — это клиническое обучение в операционной комнате с пошаговым изучением всех процедур, начинающееся с ассистенции вторым помощником и заканчивающееся полным управлением операцией, в результате которого специалист получает опыт лапароскопии [24]. Все ведущие центры в Европе установили такие программы обучения для собственного сотрудников, а так же для внешних стажеров (в соответствии с европейской программой обучения). Подобные программы оказались бы очень полезными для клинического обучения ТУР и эндоскопическим технологиям.

Передача изображения на мониторе позволяет операционной бригаде оценить уникальные анатомические особенности каждого индивидуального случая. Поэтому, даже второй ассистент полностью знает обо всех анатомических деталях и каждом шаге процедуры, особенностях выполнения операции, что сильно отличает лапароскопию от открытой хирургии, где, часто только хирург использует приборы для увеличения видимости операционного поля (лупы).

С другой стороны, в настоящее время имеется недостаточное количество мест, где можно пройти полный курс лапароскопической простатэктомии. Недавний обзор выявил, что 44 % заинтересованных в обучении европейских урологов отметили низкую доступность подобного обучения [100]. Кроме того, длительные практические программы обучения с трудом доступны для большинства урологов и аспирантов в Соединенных Штатах из-за значительных финансовых и временных затрат. Несмотря на это, в США нет формального лапароскопического учебного плана обучения резидентов в урологии для такой трудной в освоении методики.

3.4. Преимущества и перспективы лапароскопической радикальной простатэктомии

Только после семи лет оценки лапароскопической простатэктомии онкологические и функциональные результаты кажутся многообещающими и приближаются к таковым при открытой хирургии. Время операции остается все еще более длительным, чем при традиционной позадилонной простатэктомии, но многие центры, успешно занимающиеся лапароскопией, сообщают о времени лапароскопической операции, приближающейся к открытой.

Однако, есть отличные преимущества лапароскопической радикальной простатэктомии, связанные с менее агрессивным подходом:

Меньшая послеоперационная боль

Более низкий процент осложнений

Более короткий период выздоровления

Лучший косметический эффект

Это, прежде всего, связано не с лучшей техникой, а с меньшей интраоперационной травмой. Несмотря на такие результаты, Fornara [68] не обнаружил в острой стадии никакого различия между пациентами, перенесшими лапароскопическую и позадилонную простатэктомии в серологических параметрах (C-реактивный белок, интерлeйкин-6).

Дальнейший потенциал развития лапароскопической радикальной простатэктомии связан с видеоэндоскопией, обеспечивающей оптимальную визуализацию околопростатической анатомии. Это может вести к сохранению структур вокруг сфинктера (добавочная промежностная артерия), улучшить диссекцию апекса, максимально сохранить сосудисто-нервный пучок [102,103]. Кроме того, видео-обучение улучшит передачу анатомических знаний и технического ноу-хау. Однако, все это должно подтверждаться долговременными клиническими исследованиями.

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Для подготовки данной работы были использованы материалы с сайта http://www.uroweb.ru/