Learning Curve of a Laparoscopy Assisted Distal Gastrectomy for a Surgeon Expert in Performing a Conventional Open Gastrectomy

Kim, Ji Hoon; Jung, Young Soo; Kim, Byung Sik; Jeong, Oh; Lim, Jeong Taek; Yook, Jeong Hwan; Oh, Sung Tae; Park, Kun Choon

Abstract

PURPOSE: The laparoscopy assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, expert surgeons, who have performed a conventional open gastrectomy for a long time, tend to have a negative attitude toward laparoscopic procedures. The aim of this study was to determine the learning curve of a laparoscopy assisted distal gastrectomy (LADG) for a surgeon expert in performing an open gastrectomy and to analyze the factors that have an effect on a LADG.
MATERIALS AND METHODS
Between April 2005 and March 2006, 62 patients underwent a LADG with D1+beta lymph-node dissection. The 62 patients were divided into 10 sequential groups with 6 cases in each group (the last group was 8 cases), and the time required to reach the plateau of the learning curve was determined by examining the average operative times of these 10 groups. Other factors, such as sex, BMI, complications, transfusion requirements, the number of retrieved lymph nodes, and change of postoperative hemoglobin level, were also analyzed.
RESULTS
With the 5th group (after 30 cases), the operative time reached a plateau (average: 170 min/operation). The differences between before the 30th case and after the 31st case with respect to changes in the postoperative hemoglobin level, the number of retrieved lymph nodes, the transfusion requirements, and the complications rate were not significant.
CONCLUSION
According to an analysis of the operative time, experience with 30 LADGs in patients with early gastric cancer is the point at which the plateau of the learning curve (7 months) is reached. Abundant experience with a conventional open gastrectomy and a well-organized laparoscopic surgery team are important factors in overcoming the learning curve earlier.