Learning curve for laparoscopy‐assisted distal gastrectomy

Abstract

Background: Laparoscopy‐assisted distal gastrectomy (LADG) has proved to be useful in the management of early gastric cancer. The aim of the present study was to examine the learning curve for LADG and clarify any technical problems. Methods: The study included 75 consecutive patients who underwent LADG between 1994 and 2002. All operations were performed by a single surgeon and with a surgical team who were skilled in laparoscopic procedures, but new to LADG. Patients were divided into three groups according to the surgeon's level of experience at the time of surgery: Group I ( n = 25, surgeries performed between November 1994 and April 1997), Group 2 ( n = 25, surgeries performed between May 1997 and January 2000), and Group 3 ( n = 25, surgeries performed between February 2000 and August 2002). We considered Groups 1, 2 and 3 to reflect the surgeon's beginning, intermediate and advanced levels of experience, respectively. Operation time, blood loss and incidence of complications were analyzed and compared between groups. Results: Operation time and blood loss did not differ between Groups 1, 2 and 3 (operation time: 236 vs 258 vs 225 min; blood loss: 157 vs 198 vs 144 mg, respectively). Postoperative complications occurred in nine patients (12%); the incidence did not differ between groups. The most frequent complication was wound infection (4%), followed by anastomotic stenosis (3%). There were no intraoperative complications or conversions to open surgery. Conclusions: There is no learning curve for LADG, when it is performed by a skilled surgeon and surgical team. Proficiency in basic laparoscopic techniques and open gastric surgery is easily adapted to safe completion of LADG.