Training system for laparoscopy-assisted distal gastrectomy

作者：Kuroda Shinji^*; Kikuchi Satoru; Hori Naoto; Sakamoto Shuichi; Kagawa Tetsuya; Watanabe Megumi; Kubota Tetsushi; Kuwada Kazuya; Ishida Michihiro; Kishimoto Hiroyuki; Uno Futoshi; Nishizaki Masahiko; Kagawa Shunsuke; Fujiwara Toshiyoshi

来源：Surgery Today, 2017, 47(7): 802-809.

DOI：10.1007/s00595-016-1439-9

• Laparoscopy-assisted distal gastrectomy
• Gastric cancer
• Training system
• Learning curve

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.

• 出版日期2017-7