The benefits of standardizing the operative procedure for the assistant in laparoscopy-assisted gastrectomy for gastric cancer

• Published in: Langenbeck's archives of surgery Vol. 393; no. 6; pp. 963 - 971
• Main Authors: Hiki, Naoki, Fukunaga, Testsu, Yamaguchi, Toshiharu, Nunobe, Souya, Tokunaga, Masanori, Ohyama, Shigekazu, Seto, Yasuyuki, Yoshiba, Hidemaro, Nohara, Kyoko, Inoue, Harutaka, Muto, Tetsuichiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.11.2008
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Animals; Blood Loss, Surgical - physiopathology; Cardiac Surgery; Clinical Competence - standards; Female; Gastrectomy - standards; General Surgery; Humans; Laparoscopy - standards; Lymph Node Excision - standards; Lymph Nodes - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Original Article; Physician Assistants - standards; Postoperative Complications - etiology; Retrospective Studies; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Swine; Thoracic Surgery; Time and Motion Studies; Traumatic Surgery; Vagus Nerve - surgery; Vascular Surgery; LADG; Laparoscopy-assisted gastrectomy; Assistant; Gastric cancer; Standardization
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-008-0374-7

Background and aim Laparoscopy-assisted distal gastrectomy (LADG) has not yet been widely adopted for the treatment of gastric cancers because of the perceived complexity of the procedure. In addition to the proficiency of the operator, other factors could potentially be optimized to improve postoperative outcomes. The aim of this study was to evaluate a standardized operative procedure for assistants performing LADG. Materials and methods Of 114 patients, 64 initially underwent conventional LADG (CLDG) and then 50 underwent standardized procedure (SLDG) in which the role of assistant in LADG was completely established. Parameters compared for the SLDG and CLDG groups were operation time, estimated blood loss, intra- or postoperative complications, preservation of the vagus nerve, and the number of pathologically examined lymph nodes. Results The operation time for the SLDG procedure (mean ± SE, 229 ± 6 min) was shorter than for the CLDG procedure (261 ± 8 min; P  < 0.002), and the estimated blood loss for SLDG (57 ± 7 ml) was less than for CLDG (108 ± 17 ml, P  < 0.004). The celiac branch of the vagus nerve was preserved in 73% of SLDG patients compared with 52% of CLDG patients ( P  < 0.03). More lymph nodes were pathologically examined in SLDG patients (38.3 ± 1.5) than in CLDG patients (32.5 ± 1.8, P  = 0.02). Conclusions Standardization of the LADG procedure for assistants enabled a shorter operation time, reduced blood loss, a higher rate of vagus nerve preservation, and more accurate lymph node dissection.