Education and introduction of laparoscopic gastrectomy. -The importance of the first assistant-

Ryohei Watanabe, MD, PhD, Yoichi Nakamura, Sayaka Nagao, Kazuhiro Takabayashi, Toshiyuki Enomoto, Koji Asai, Manabu Watanabe, Yoshihisa Saida, Shinya Kusachi, Jiro Nagao. Toho University Ohashi Medical center, Department of Surgery

We started laparoscopy-assisted gastrectomy (LAG) for gastric cancer in 2012. As a result of improved educational method during the 3 periods (period: 1. 2. 3), operation time was significantly reduced. We report our educational method for LAG. (Methods) Operator of the every cases was qualified surgeon of japan society for endoscopic surgery. First assistant doctor was secured during 3 period. Period1: 5 cases of first introduction. Operator educates assistant doctor during operation. Period2: 12 cases. After creation a surgical procedure manual of LAG for scrub nurse, teach it for scrub nurse. Period3: 10 cases. After creation a surgical procedure manual for doctor, and teach it to assistant doctor. I let the preparation and review to assistant doctor using surgical procedure manual and video. (Results) 27cases, Male 15 : Female 12, mean BMI 23 (18-29), LADG 26 cases, LATG 1 case, lymph node dissection : D1+8a,9,11p, vagus nerve preservation rates : hepatic branch 100%, hepatic and celiac branch 88.9%, postoperative length of stay : mean 9 days (7-21). Period1: operation time 356 minutes, amount of bleeding 4 ml. Period2 : operation time 324 minutes, amount of bleeding 16 ml. Period3 : operation time 287 minutes, amount of bleeding 14 ml. We also count the time of operator’s procedure and the time of 1st assistant doctor’s procedure. The time of 1st assistant doctor’s procedure is decreased significantly, although the time of operator’s procedure is almost same during 3 periods. (Conclusion) Result in the improvement of education for the surgical nurse, assistant doctors, operation time was reduced stepwise significantly during 3 periods.

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