Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1606-1613
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1606
Learning curve for hand-assisted laparoscopic D2 radical gastrectomy
Jia-Qing Gong, Yong-Kuan Cao, Yong-Hua Wang, Guo-Hu Zhang, Pei-Hong Wang, Guo-De Luo
Jia-Qing Gong, Yong-Kuan Cao, Yong-Hua Wang, Guo-Hu Zhang, Pei-Hong Wang, Guo-De Luo, Center of General Surgery, the People’s Liberation Army General Hospital of Chengdu Command, Chengdu 610083, Sichuan Province, China
Author contributions: Gong JQ and Cao YK contributed equally to this manuscript; Gong JQ and Cao YK performed the research, analyzed the data, and wrote the paper; Wang YH analyzed the data and wrote the paper; Zhang GH, Wang PH and Luo GD helped to collect and analyze the data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Jia-Qing Gong, MD, PhD, Center of General Surgery, the People’s Liberation Army General Hospital of Chengdu Command, Jinniu District, Chengdu 610083, Sichuan Province, China. cdgjq123@126.com
Telephone: +86-28-86570621 Fax: +86-28-86570621
Received: July 30, 2014
Peer-review started: July 31, 2014
First decision: August 15, 2014
Revised: August 22, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: February 7, 2015
Processing time: 194 Days and 2.6 Hours
Abstract

AIM: To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of gastric cancer.

METHODS: The HALG surgical procedure consists of three stages: surgery under direct vision via the port for hand assistance, hand-assisted laparoscopic surgery, and gastrointestinal tract reconstruction. According to the order of the date of surgery, patients were divided into 6 groups (A-F) with 20 cases in each group. All surgeries were performed by the same group of surgeons. We performed a comprehensive and in-depth retrospective comparative analysis of the clinical data of all patients, with the clinical data including general patient information and intraoperative and postoperative observation indicators.

RESULTS: There were no differences in the basic information among the patient groups (P > 0.05). The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups, with the difference being statistically significant (P = 0.01). There were no differences in total operative time between the groups (P = 0.30). Postoperative intestinal function recovery time in group A was longer than that of other groups (P = 0.02). Lengths of hospital stay and surgical quality indicators (such as intraoperative blood loss, numbers of detected lymph nodes, intraoperative side injury, postoperative complications, reoperation rate, and readmission rate 30 d after surgery) were not significantly different among the groups.

CONCLUSION: HALG is a surgical procedure that can be easily mastered, with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.

Keywords: Learning curve; Gastric cancer; Hand-assisted laparoscopic D2 radical gastrectomy; Operative time; Surgical quality indicators

Core tip: In order to explore the learning curves and impact factors of hand-assisted laparoscopic D2 radical gastrectomy (HALG) for the treatment of advanced gastric cancer, plenty of pre-, intra-, and post-operative data was involved in this study. We found that the HALG learning curve was closely related to the operative time of the hand-assisted laparoscopic surgery stage and was not related to surgical quality indicators. The HALG learning curve indicates that it is a surgical procedure that can be easily mastered.