J Gastric Cancer.  2018 Jun;18(2):172-181. 10.5230/jgc.2018.18.e18.

Transition from Conventional to Reduced-Port Laparoscopic Gastrectomy to Treat Gastric Carcinoma: a Single Surgeon's Experience from a Small-Volume Center

• Kim HG
• Kim DY
• Jeong O

• KMID: 2414537
• DOI: http://doi.org/10.5230/jgc.2018.18.e18

Abstract

PURPOSE
This study aimed to evaluate the surgical outcomes and investigate the feasibility of reduced-port laparoscopic gastrectomy using learning curve analysis in a small-volume center.
MATERIALS AND METHODS
We reviewed 269 patients who underwent laparoscopic distal gastrectomy (LDG) for gastric carcinoma between 2012 and 2017. Among them, 159 patients underwent reduced-port laparoscopic gastrectomy. The cumulative sum technique was used for quantitative assessment of the learning curve.
RESULTS
There were no statistically significant differences in the baseline characteristics of patients who underwent conventional and reduced-port LDG, and the operative time did not significantly differ between the groups. However, the amount of intraoperative bleeding was significantly lower in the reduced-port laparoscopic gastrectomy group (56.3 vs. 48.2 mL; P < 0.001). There were no significant differences between the groups in terms of the first flatus time or length of hospital stay. Neither the incidence nor the severity of the complications significantly differed between the groups. The slope of the cumulative sum curve indicates the trend of learning performance. After 33 operations, the slope gently stabilized, which was regarded as the breakpoint of the learning curve.
CONCLUSIONS
The surgical outcomes of reduced-port laparoscopic gastrectomy were comparable to those of conventional laparoscopic gastrectomy, suggesting that transition from conventional to reduced-port laparoscopic gastrectomy is feasible and safe, with a relatively short learning curve, in a small-volume center.

Keyword

Stomach neoplasms; Gastrectomy; Laparoscopy; Learning curve

MeSH Terms

Flatulence
Gastrectomy*
Hemorrhage
Humans
Incidence
Laparoscopy
Learning
Learning Curve
Length of Stay
Operative Time
Stomach Neoplasms

Figure

• 

  Fig. 1 Operative images of reduced-port laparoscopic gastrectomy. (A) Placement of abdominal ports; (B) Liver retraction using nylon suture; (C) Suprapancreatic lymph node dissection; (D) Removal of lymph node No. 11p.

• 

  Fig. 2 Operative time and CUSUM curves of RPG. Green lines indicate breakthrough points (17th and 33rd case). CUSUM = cumulative sum; RPG = reduced-port gastrectomy.

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