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
ARTICLE HIGHLIGHTS
Research background
Total laparoscopic distal gastrectomy (TLDG), which involves technically complex elements and requires dedicated skills, has generated interest and desire not only in surgeon pioneers but also in trainee surgeons. The rapid expansion of TLDG has led to concern about education for young surgeons.
Research motivation
Fewer opportunities to perform open gastrectomy and higher technical demands has made laparoscopic training procedures for young surgeons differ from those of laparoscopic surgeon pioneers. Appropriate and efficient training systems suitable for the current situation need to be urgently established.
Research objectives
The patients underwent TLDG plus Billroth I reconstruction from June 2016 to June 2019. Clinical, surgical and pathological data of these patients were collected and analyzed.
Research methods
This study assessed our laparoscopic training system for TLDG based on short-term surgical outcomes. We reviewed ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using the augmented rectangle technique. The trainees were required to receive systematic laparoscopic training. The total procedure of TLDG was divided into different regional lymph node dissection and gastrointestinal reconstruction for analyzing. Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees.
Research results
Five trainees performed a total of 52 TLDG (56.5%), while 40 TLDG were conducted by the two trainers (43.5%). Except for depth of invasion and pathology stage, there were no differences in patient clinicopathological characteristics. Trainers performed more D2 gastrectomies than trainees. The total operation time was significantly longer in the trainees. The time spent on less curvature lymph node dissection and Billroth I reconstruction was 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.
Research conclusions
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.
Research perspectives
Making laparoscopic procedures standard and using an easy reconstruction method are useful in the success of the training system.
