논문검색
Author Han-Gil Kim1,2, Ji-Ho Park1,2, Sang-Ho Jeong1,2,3, Young-Joon Lee1,2,3, Woo-Song Ha1,2,3, Sang-Kyung Choi1,2,3, Soon-Chan Hong1,2,3, Eun-Jung Jung1,2,3, Young-Tae Ju1,2,3, Chi-Young Jeong1,2,3, and Taejin Park1,2,3
Place of duty 1Department Surgery, Postgraduate School of Medicine, Gyeongsang National University, 2Gyeongnam Regional Cancer Center, 3Institue of Health Sciences, Gyeongsang National University, Jinju, Korea
Title Totally Laparoscopic Distal Gastrectomy after Learning Curve Completion: Comparison with Laparoscopy -Assisted Distal Gastrectomy
Publicationinfo Journal of Gastric Cancer 2013 Mar; 013(01): 26-33.
Key_word Laparoscopy; Stomach neoplasms; Anastomosis; Learning curve; Morbidity
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Abstract Purpose: The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. Materials and Methods: From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. Results: Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy- assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). Conclusions: Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy after learning curve completion is a feasible and timesaving method compared to laparoscopy-assisted distal gastrectomy.
출판정보 대한위암학회지 2013 Mar; 013(01): 26-33.

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