Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy
Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy作者机构：Department of Gastrointestinal Surgery Osaka City General Hospital Osaka Japan Department of Surgery Gohshi Hospital Hyogo Japan
出 版 物：《International Journal of Clinical Medicine》 (临床医学国际期刊（英文）)
年 卷 期：2013年第4卷第6期
页 面：28-34页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Laparoscopic-Assisted Distal Gastrectomy Learning Training System
摘 要：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 trai
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