J Gastric Cancer.  2018 Jun;18(2):182-188. 10.5230/jgc.2018.18.e20.

Learning Curve of Pure Single-Port Laparoscopic Distal Gastrectomy for Gastric Cancer

• Lee B
• Lee YT
• Park YS
• Ahn SH
• Park DJ
• Kim HH

• KMID: 2414538
• DOI: http://doi.org/10.5230/jgc.2018.18.e20

Abstract

PURPOSE
Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG.
MATERIALS AND METHODS
A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group.
RESULTS
Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%:8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%:38.5%). The operative time of surgeon B significantly decreased after 30 cases (157.8±38.4 minutes vs. 118.1±34.5 minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases (160.8±51.6 minutes vs. 173.3±35.2 minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of < 25 kg/m2 ( < 25 kg/m2:≥25 kg/m2, 159.3±41.7 minutes: 194.25±81.1 minutes; P=0.001).
CONCLUSIONS
Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of < 25 kg/m2 was found to be a favorable factor for SPDG.

Keyword

Stomach neoplasms; Laparoscopy; Learning curve; Gastrectomy

MeSH Terms

Body Mass Index
Gastrectomy*
Humans
Laparoscopy
Learning Curve*
Learning*
Methods
Operative Time
Sex Ratio
Stomach Neoplasms*
Surgeons

Figure

• 

  Fig. 1 Learning curve (surgeon A). For analyzing the learning curve of each surgeon, cases were extracted from 6 (surgeon A) sequential groups. The mean operative time in each group was calculated. The operative time was shorter in the beginning but increased after the middle group with surgeon A.

• 

  Fig. 2 Learning curve (surgeon B). For analyzing the learning curve of each surgeon, cases were extracted from 5 (surgeon B) sequential groups. The mean operative time in each group was calculated. Surgeon B showed a steady state after 30 cases of single-port laparoscopic distal gastrectomy.

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