Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center

Laparoscopy-assisted gastrectomy (LAG) is increasingly performed in Japan by a number of surgeons. As this is a relatively new technique, a training system is important, however there has been little discussion about an educational system for teaching trainees to perform LAG and the ideal training system has not yet been established.

Two hundred and sixty-three patients who underwent LAG at the Cancer Institute Hospital were included in this study. In all cases there was standardization of LAG (the way in which the surgical field was formed by the assistant and the way the operator dissected the lymph nodes was determined and all cases were performed using the same laparoscopic procedures) and a step-by-step training system was completed. Specialists performed the surgery in 213 patients (S group) while the remaining 50 patients had their surgery performed by trainees (T group). Early surgical outcomes were compared between specialists and trainees to clarify whether the standardization and our educational system are useful in maintaining the quality of LAG.

T-group patients had significantly longer operation times than those of S-group (262.3 +/- 7.3 versus 233.3 +/- 3.7 min), however, the trainees reached the plateau of their learning curve earlier than previously reported. All other early surgical outcomes examined, including intraoperative blood loss (76.7 +/- 35.1 versus 64.9 +/- 7.7 ml), number of retrieved lymph nodes (33.4 +/- 1.4 versus 35.7 +/- 0.8), morbidity (8 versus 14%), and mortality (0% in both groups), were not significantly different between the two groups.

The surgical results of T-group were almost equal to those of S-group, showing that our educational system is effective and surgical quality is maintained. Standardized laparoscopic procedures and sufficient intensive experience in the short term are requisites for effectively learning how to perform LAG.