PMID- 32308349
OWN - NLM
STAT- MEDLINE
DCOM- 20210122
LR  - 20210122
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 26
IP  - 13
DP  - 2020 Apr 7
TI  - Effectiveness and safety of a laparoscopic training system combined with modified 
      reconstruction techniques for total laparoscopic distal gastrectomy.
PG  - 1490-1500
LID - 10.3748/wjg.v26.i13.1490 [doi]
AB  - 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.
CI  - (c)The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - Zhang, Shun
AU  - Zhang S
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Orita, Hajime
AU  - Orita H
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan. oriori@juntendo.ac.jp.
FAU - Egawa, Hiroyuki
AU  - Egawa H
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Matsui, Ryota
AU  - Matsui R
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Yamauchi, Suguru
AU  - Yamauchi S
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Yube, Yukinori
AU  - Yube Y
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Kaji, Sanae
AU  - Kaji S
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Takahashi, Toru
AU  - Takahashi T
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Oka, Shinichi
AU  - Oka S
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Inaki, Noriyuki
AU  - Inaki N
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
FAU - Fukunaga, Tetsu
AU  - Fukunaga T
AD  - Department of Gastroenterology and Minimally Invasive Surgery, Juntendo 
      University Hospital, Tokyo 113-8431, Japan.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
SB  - IM
MH  - Adult
MH  - Clinical Competence/statistics & numerical data
MH  - Female
MH  - Gastrectomy/*education/methods
MH  - Gastroenterostomy/*education/methods
MH  - Humans
MH  - Laparoscopy/*education/methods
MH  - Learning Curve
MH  - Male
MH  - Operative Time
MH  - Retrospective Studies
MH  - Surgeons/*education
MH  - *Teaching
MH  - Treatment Outcome
PMC - PMC7152525
OTO - NOTNLM
OT  - Augmented rectangle technique
OT  - Education system
OT  - Gastric cancer
OT  - Standard procedure
OT  - Total laparoscopic gastrectomy
OT  - Trainees
COIS- Conflict-of-interest statement: The authors have no conflicts of interest to 
      disclose.
EDAT- 2020/04/21 06:00
MHDA- 2021/01/23 06:00
PMCR- 2020/04/07
CRDT- 2020/04/21 06:00
PHST- 2019/12/12 00:00 [received]
PHST- 2020/02/14 00:00 [revised]
PHST- 2020/03/05 00:00 [accepted]
PHST- 2020/04/21 06:00 [entrez]
PHST- 2020/04/21 06:00 [pubmed]
PHST- 2021/01/23 06:00 [medline]
PHST- 2020/04/07 00:00 [pmc-release]
AID - 10.3748/wjg.v26.i13.1490 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2020 Apr 7;26(13):1490-1500. doi: 
      10.3748/wjg.v26.i13.1490.