Masafumi Ohira. Department of Gastroenterological Surgery, Hokkaido University Graduate School of Medicine
Background: In laparoscopic surgery, both surgical technique and adequate support and traction by an assistant are highly important. This study assessed the impact of the first assistant on short-term outcomes of laparoscopic distal gastrectomy (LDG) and laparoscope-assisted distal gastrectomy (LADG).
Methods: Patients who underwent LDG or LADG for gastric cancer at our hospital, between November 2013 and August 2017, were included. LDG and LADG cases of Billroth I reconstruction, performed by a single surgeon accredited in endoscopic procedures, were analyzed. The cases were categorized into the following 4 groups according to the first assistant’s postgraduate years (PGY) of experience: group A, 3–5 years; group B, 6–10 years; group C, 11–15 years; and group D, >16 years. Short-term outcomes were compared between the groups.
Results: We examined 48 cases. Operative time was significantly longer in group A than in group B (P = 0.029). No significant differences in operative time were found between groups B, C, and D. The cases were recategorized into 2 groups as follows: group A, the young assistant group (group Y, n = 8), and groups B, C, and D, the senior assistant group (group S, n = 40). Significant differences in operative time and method of anastomosis (circular stapler or delta anastomosis) were observed between the 2 groups (P = 0.0054 and P = 0.0028, respectively), but no significant differences in complication rates were found (P = 1.0000). The unadjusted analysis revealed that the group, method of anastomosis, and body mass index (BMI) were significant factors associated with longer operative time. Multivariate linear regression analysis with stepwise model selection using Akaike’s information criterion (AIC) revealed that BMI and group were significant factors associated with longer operative time (P = 0.0075 and P = 0.0024, respectively). Multivariate analysis using these 2 variables and the method of anastomosis confirmed the significance of BMI and group for longer operative time, but no significance was found in the method of anastomosis (P = 0.0088, P = 0.021, and P = 0.51, respectively).
Conclusions: Our study showed that operative time tended to be longer when the first assistant had experience of less than 6 PGY, but the morbidity did not increase. As with the operator, the first assistant needs adequate training to ensure a smooth operation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84787
Program Number: P453
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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