Training system for laparoscopy-assisted distal gastrectomy

Abstract

Purpose: Laparoscopy-assisted distal gastrectomy (LADG) is likely to become a standard procedure for gastric cancer, which highlights the importance of establishing a training system in which even inexperienced surgeons can perform this procedure safely. This study assesses our training system for LADG based on short-term surgical outcomes.

Methods: We evaluated retrospectively the short-term outcomes of 100 consecutive LADGs with curative D1/D1+ lymph node dissection. Our training system was assessed based on the learning curve of trainees, and factors related to achieving good-quality operations were analyzed statistically.

Results: Overall, postoperative complications developed in 10 patients (10%), and included one case of anastomotic leakage (1%) and one case of pancreatic fistula (1%). The learning curve of the trainees plateaued after 10 operator cases in terms of operation time. The importance of the trainer's position was also confirmed by the result that the operation time was significantly longer when trainees with ≤10 operator cases performed LADG with a trainer as scopist vs. a trainer as the first assistant. Univariate and multivariate analyses revealed that >10 operator cases were the most important factor for achieving good-quality operations.

Conclusion: These results show that our current LADG procedure and training system are appropriate and effective.

Keywords: Gastric cancer; Laparoscopy-assisted distal gastrectomy; Learning curve; Training system.

Fig. 1

Port placement

Fig. 2

Learning curve of the trainees. a Average operation time for laparoscopy-assisted distal gastrectomy (LADG) performed by the trainees, divided into four groups depending on each operator’s experience (1–5, 6–10, 11–20, and more than 20 cases), was compared among the groups and also with that of operations performed by qualified surgeons. b Same comparison was done for average blood loss. c For the operations done by trainees with operator experience of 20 cases or less, the influence of the trainer’s position, as the first assistant or scopist, on operation time was evaluated