Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Effectiveness and safety of a laparoscopic training system combined with modified reconstruction techniques for total laparoscopic distal gastrectomy
Shun Zhang, Hajime Orita, Hiroyuki Egawa, Ryota Matsui, Suguru Yamauchi, Yukinori Yube, Sanae Kaji, Toru Takahashi, Shinichi Oka, Noriyuki Inaki, Tetsu Fukunaga
Shun Zhang, Hajime Orita, Hiroyuki Egawa, Ryota Matsui, Suguru Yamauchi, Yukinori Yube, Sanae Kaji, Toru Takahashi, Shinichi Oka, Noriyuki Inaki, Tetsu Fukunaga, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
Shun Zhang, Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, China
Ryota Matsui, Toru Takahashi, Noriyuki Inaki, Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, Chiba 2790021, Japan
Author contributions: All authors performed the research; Zhang S and Orita H contributed to manuscript writing, performing procedures and data analysis; Egawa H, Matsui R, Yube Y, Kaji S, Takahashi T and Oka S contributed to performing procedures and data analysis; Egawa H and Matsui R contributed to writing the manuscript; Zhang S, Yamauchi S and Inaki N contributed to data analysis and statistical review; Orita H and Fukunaga T contributed to writing the manuscript and drafting the conception and design of this work.
Supported by Japan China Sasakawa Medical Fellowship and the China Scholarship Council, No. 201908310012.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Committee of Juntendo University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because our study was done retrospectively. Data for study were obtained after each patient agreed to treatment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hajime Orita, MD, PhD, Associate Professor, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan. oriori@juntendo.ac.jp
Received: December 12, 2019
Peer-review started: December 12, 2019
First decision: January 19, 2020
Revised: February 14, 2020
Accepted: March 5, 2020
Article in press: March 5, 2020
Published online: April 7, 2020
BACKGROUND
Total laparoscopic distal gastrectomy (TLDG) is increasing due to some advantages over open surgery, which has generated interest in gastrointestinal surgeons. However, TLDG is technically demanding especially for lymphadenectomy and gastrointestinal reconstruction. During the course of training, trainee surgeons have less chances to perform open gastrectomy compared with that of senior surgeons.
AIM
To evaluate an appropriate, efficient and safe laparoscopic training procedures suitable for trainee surgeons.
METHODS
Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were reviewed. The trainees were taught a laparoscopic view of surgical anatomy, standard operative procedures and practiced essential laparoscopic skills. The TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee skills. Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees. Learning curves were used to assess the utility of our training system.
RESULTS
Five trainees performed a total of 52 TLDGs (56.5%), while 40 TLDGs were conducted by two trainers (43.5%). Except for depth of invasion and pathologic stage, there were no differences in clinicopathological characteristics. Trainers performed more D2 gastrectomies than trainees. The total operation time was significantly longer in the trainee group. The time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two groups. No difference was found in postoperative complications between the two groups. The learning curve of the trainees plateaued after five TLDG cases.
CONCLUSION
Preparing trainees with a laparoscopic view of surgical anatomy, standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG safely and feasibly.
Core tip: The rapid expansion of total laparoscopic distal gastrectomy has led to concern about education for young surgeons. Laparoscopic training for young surgeons differs from training experienced previously due to fewer opportunities to perform open gastrectomy and higher technical demands. We introduced our laparoscopic training system and found that making a standard laparoscopic procedure and using the easy reconstruction method are useful in the success of the training system.
