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The learning curve associated with laparoscopic total gastrectomy.

Do Hyun Jung¹, Sang-Yong Son¹, Young Suk Park¹

¹Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-Si, Gyenggi-do, 463-707, Korea.

Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association

|December 8, 2014

Summary

Laparoscopic total gastrectomy (LTG) requires significant surgical skill. This study found that approximately 100 cases are needed to master the LTG procedure, with consistent outcomes achieved after this learning period.

Keywords:

Laparoscopic total gastrectomy Learning curve Stomach neoplasms

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Area of Science:

Surgical Oncology
Minimally Invasive Surgery
Gastrointestinal Surgery

Background:

Laparoscopic total gastrectomy (LTG) is increasingly performed but technically demanding.
Ensuring oncological safety and procedural efficiency are key concerns for LTG.
Defining the learning curve is crucial for surgeon training and patient outcomes.

Purpose of the Study:

To define the learning curve for laparoscopic total gastrectomy (LTG).
To identify the number of cases required for surgical proficiency in LTG.
To analyze operative outcomes and complications during the LTG learning process.

Main Methods:

A retrospective analysis of 256 consecutive laparoscopic total gastrectomy (LTG) cases was performed.
Cases were grouped into ten sets of 25 to analyze the learning curve using the moving average method.
Operative time, estimated blood loss (EBL), lymph node retrieval, hospital stay, and complications were evaluated.

Main Results:

A three-phase learning curve for LTG was identified, with significant reductions in operative time and EBL observed.
Mean operative time decreased from 244.8 min in early phases to 207.8 min in later phases (p=0.003).
Mean EBL decreased from 237.0 ml to 116.5 ml (p<0.001), with similar complication and conversion rates across phases.

Conclusions:

Approximately 100 cases of LTG are required to achieve proficiency.
Surgical outcomes, including operative time and blood loss, significantly improve after the initial learning phase.
The learning curve for LTG is well-defined, with consistent results achievable after sufficient experience.