Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1490
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
Processing time: 117 Days and 7.5 Hours
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.
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.
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.
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.
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.
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.
Making laparoscopic procedures standard and using an easy reconstruction method are useful in the success of the training system.