TITLE:
Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy
AUTHORS:
Masashi Takemura, Katsuyuki Mayumi, Takashi Ikebe, Sinya Tanimura
KEYWORDS:
Laparoscopic-Assisted Distal Gastrectomy; Learning; Training System
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.4 No.6A,
June
20,
2013
ABSTRACT: Aim: Laparoscopy-assisted distal
gastrectomy (LADG) with regional lymph node dissection is a treatment option
for patient with early gastric cancer. However, LADG is a technically complex
and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively
evaluated the learning curve for LADG of a single surgeon with no previous
experience in LADG and the usefulness of direct instruction by a surgeon
experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive
patients, who underwent LADG by a single surgeon (first assistant in 10 cases
and operator in 70 cases) between January 2008 and December 2012. Patients were
divided into 3 sequential groups of 10 (training period), 30 (learning period),
and 40 (operating period) cases in each group. Median operation time and
estimated blood loss for these 3 groups were determined. Other learning indicators,
including transfusion requirement, postoperative complications, number of lymph
node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the
training period, median
operation time and estimated blood loss were 219.5 min and 83.0 ml,
respectively. During the learning period, the operation time was significantly
longer than that of training period. In the operating period, the operation
time was significantly
lesser than that during the learning period. However, the operation time was
not different from that during the training period and reached a plateau. The
estimated blood loss during the operating period was significantly lesser than
that during the learning period. The difference in the number of lymph nodes retrieved
between each group was not significant. Conclusions: Direct instructions by an experienced
surgeon can decrease the number of cases required for learning. Because LADG is
technically more complex than other laparoscopic procedures, standardization of
LADG and an effective training system for performing it should be established.