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Related Experiment Video

Updated: Sep 5, 2025

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
03:32

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Published on: December 27, 2024

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Learning Curve of Laparoscopic Gastrectomy: A Multicenter Study.

Hylke J F Brenkman1, Linda Claassen2, Gerjon Hannink2

  • 1University Medical Center Utrecht, Utrecht, The Netherlands.

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|July 8, 2022
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Summary

This study found no learning curve for anastomotic leakage in laparoscopic gastrectomy (LG). However, a learning curve effect was observed for overall complications and conversion rates in high-volume centers.

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Area of Science:

  • Surgical Oncology
  • Minimally Invasive Surgery
  • Gastrointestinal Surgery

Background:

  • Laparoscopic gastrectomy (LG) is increasingly adopted globally for gastric cancer.
  • Limited data exists on the learning curve associated with LG procedures.
  • Understanding the learning curve is crucial for optimizing surgical outcomes and training.

Purpose of the Study:

  • To evaluate the learning curve of laparoscopic gastrectomy (LG) following an implementation program.
  • To assess the impact of surgical experience on key outcomes in LG.
  • To identify the number of cases required to achieve proficiency in LG.

Main Methods:

  • Analysis of 540 consecutive LG procedures for gastric adenocarcinoma across 5 high-volume Dutch centers.
  • Utilized generalized additive models and a 2-piece model to determine learning curve length.
  • Corrected for casemix and analyzed outcomes including anastomotic leakage, complications, and conversions for LG, distal gastrectomy (LDG), and total gastrectomy (LTG).

Main Results:

  • No significant learning curve effect was identified for anastomotic leakage in LG; a plateau of 10% was reached after 36 cases.
  • A learning curve plateau for overall complications was observed after 20 cases (38% rate).
  • Conversion rates plateaued at 5%; outcomes for LDG and LTG individually showed fluctuations related to casemix.

Conclusions:

  • No learning curve effect was identified for anastomotic leakage in LG among experienced surgeons in high-volume centers.
  • A learning curve effect was demonstrated for overall complications and the rate of conversion to open surgery in LG.
  • These findings suggest that while basic proficiency in LG may be achieved quickly, refinement in managing complications and avoiding conversions requires more experience.