J Gastric Cancer.  2015 Dec;15(4):270-277. 10.5230/jgc.2015.15.4.270.

Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach

• You YH
• Kim YM
• Ahn DH

• KMID: 2391562
• DOI: http://doi.org/10.5230/jgc.2015.15.4.270

Abstract

PURPOSE
Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon.
MATERIALS AND METHODS
Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups.
RESULTS
MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity.
CONCLUSIONS
This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon.

Keyword

Minimally invasive surgical procedures; Stomach neoplasms; Laparoscopy; Robotics; Beginner surgeon

MeSH Terms

Body Mass Index
Demography
Fellowships and Scholarships
Gastrectomy*
Humans
Internship and Residency
Laparoscopy
Learning
Leukocyte Count
Lymph Node Excision
Mortality
Operative Time
Robotics
Stomach Neoplasms*
Surgical Procedures, Minimally Invasive

Figure

• 

  Fig. 1 Mean hemoglobin level (A, B) and white blood cell count (C, D) after gastrectomy. Preop = preoperative; POD = postoperative day; ODG = open distal subtotal gastrectomy; MIG = minimally invasive gastrectomy; LDG = laparoscopic distal subtotal gastrectomy; RDG = robotic distal subtotal gastrectomy; WBC = white blood cell. *P-value for over time within subject; †P-value between or among the groups; ‡P-value between or among the groups considering time effect within the patients.

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