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Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning
Guillaume Giudicelli1,2, Michele Diana3,4,5, Mickael Chevallay3,6
1Department of Surgery, Neuchâtel Hospital, Rue de la Maladière 45, 2000, Neuchâtel, Switzerland. guillaume.giudicelli@rhne.ch.
Obesity Surgery
|October 13, 2020
Summary
Training general surgeons in laparoscopic Roux-en-Y gastric bypass (LRYGB) is safe. A trainee surgeon achieved outcomes comparable to global benchmarks, demonstrating safe bariatric surgery training in peripheral settings.
Area of Science:
- Bariatric Surgery
- Minimally Invasive Surgery
- Surgical Training
Background:
- Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a complex procedure with a steep learning curve.
- Concerns exist regarding potential increased morbidity during the training of new bariatric surgeons.
- This study investigates the feasibility of training general laparoscopic surgeons in LRYGB in peripheral centers.
Purpose of the Study:
- To evaluate the safety and efficacy of training general laparoscopic surgeons in LRYGB.
- To compare perioperative outcomes of a trainee surgeon against global benchmarks and a senior surgeon.
- To assess the impact of training on morbidity and operative time.
Main Methods:
- Prospective inclusion of 213 consecutive patients undergoing primary LRYGB between 2014 and 2017.
- Procedures performed by a senior surgeon (A) or a trainee surgeon (B).
- Comparison of all-cause morbidity at 90 days with global benchmarks and analysis of operative times for the first and last 30 procedures for each surgeon.
Main Results:
- Overall 90-day all-cause morbidity was 8% (17/213), with 95.3% of patients discharged uneventfully.
- The trainee surgeon (B) achieved perioperative outcomes within global benchmark cutoffs.
- Operative time for the trainee significantly decreased, approaching that of the senior surgeon by the end of the study period.
Conclusions:
- Training general laparoscopic surgeons in LRYGB in peripheral settings is safe and does not increase patient morbidity.
- Perioperative outcomes achieved by the trainee surgeon were comparable to international high-volume centers.
- Improved operative times for both surgeons suggest a successful training program and learning curve progression.
