A practical way to overcome the learning period of laparoscopic gastrectomy for gastric cancer

초록

Although laparoscopic gastrectomy is widely performed in patients with gastric cancer, it requires a learning period for surgeons. Few methods are known to reduce or overcome this learning period. We tested a method to reduce or overcome this learning period in the beginner surgeon. Between April 2009 and March 2010, a total of 139 patients underwent laparoscopic gastrectomy by a beginner surgeon. During their training period of 6 months, the beginner had been the first assistant during 200 laparoscopic gastrectomies. To evaluate surgical outcomes as the surgeon started to perform laparoscopic gastrectomy, outcomes were assessed in 79 patients who underwent laparoscopic-assisted distal gastrectomy with extracorporeal gastroduodenostomy (LADG); the first 30 were performed by the surgeon and 49 were performed subsequently. Outcomes of LADG and totally laparoscopic distal gastrectomy with intracorporeal gastroduodenostomy (TLDG) were compared to evaluate the beginner's ability to adapt to intracorporeal reconstruction. The learning period was assessed by dividing patients who underwent LADG and TLDG into sequential groups of five each by time. No patient was converted to open surgery and none died. There were no significant differences between the first 30 patients and the next 49 who underwent LADG in surgical outcomes. The only significantly different outcome between LADG and TLDG was in operation time (95.9 min vs. 115.6 min, P < 0.001). There were no significant differences in mean operation times of sequential groups (LADG, P = 0.069; TLDG, P = 0.212). The beginning surgeon examined in this work obtained satisfactory surgical outcomes during the early period of performing laparoscopic gastrectomy. We speculate that participation in laparoscopic gastrectomy team of experts improved the beginner's surgical outcomes, suggesting that such participation may reduce or overcome the learning period of beginners.

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