Laparoscopy assisted distal gastrectomy (LADG) is widely accepted as a new standard surgical treatment for early gastric cancer. However, LADG is a difficult operation with long learning curve. A training program for LADG was still premature. A beginner surgeon made a great effort for starting this surgery at inexperienced institute. Lecture video or text book was used for first case usually, but it was not enough to perform safe advanced laparoscopic surgery. It is often pointed out that most of the complications occured in early cases. In our opiniona profesional preceptor ofadvanced laparoscopic surgery would be nesessary to introduce LADG to the inexperienced instituition. In our district, a training program was made for these surgeon wanting to start LADG and an experienced preceptor of LADG visited to these hospitals and trained a beginner surgeon. This paper will present our training program for the institute aiming safe LADG start and to assess the impact of an experienced laparoscopic surgeon preceptor on the outcome of LADG among our related hospitals
Method: A basic program for training the surgeon included the step by step style was established and a preceptor visited each related hospitals. First step is observing the surgery as a first assistant or camera assistant for one or two cases, next step is performing the operation as a primary surgeon assisted by a preceptor for first ten cases, third step is performing the operation as a primal surgeon without assistance of a preceptor, but with intraoperative commentary from a preceptor. The preceptor surgeon experienced over 500 LADG for 11 years and had a teaching knowhow. Surgical procedure was standardized among related hospitals.
Results: This program was implemented at 5 related hospitals. From April 2004, 111 cases were performed. Average operation time and blood loss was 272 minutes and 155 ml. There were no conversion case and intraoperative trouble. Two leakages and 6 pancreas troubles were occurred in this series.
Conclusion: Our teaching program satisfied with its results on the points of blood loss, operation time, and safety. A visiting preceptor who specialized laparoscopic surgery will accomplish a important role for the safe spread.
Program Number: P351