title: Leveling the learning curve for laparoscopic bariatric surgery.
abstract: BACKGROUND
  The learning curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality.
  
  
  METHODS
  The study included the first 100 patients undergoing laparoscopic Roux-en-Y gastric bypass (LGB) by a designated surgical team. Surgeon A operated as primary surgeon, with surgeon B assisting (Stage 1). Surgeon B learned LGB in stages: exposure and jejunojejunostomy (stage 2), gastric pouch (stage 3), gastrojejunostomy (stage 4), and sequence all steps (stage 5).
  
  
  RESULTS
  Surgeon A achieved confidence with LGB after 20 cases and surgeon B after 25 cases (stage 2), 18 cases (stage 3), 21 cases (stage 4), and 16 cases (stage 5). Complications (8%) included small bowel obstruction (three); pulmonary embolus (two), and leak, stomal stenosis, and gastrogastric fistula (one each). There was a decreasing trend for operative duration, length of stay, and complications across the five stages (p < 0.05).
  
  
  CONCLUSIONS
  By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: M
authors.initials: M
authors.lastname: Lublin
authors.forename: S
authors.initials: S
authors.lastname: Lyass
authors.forename: B
authors.initials: B
authors.lastname: Lahmann
authors.forename: S A
authors.initials: SA
authors.lastname: Cunneen
authors.forename: T M
authors.initials: TM
authors.lastname: Khalili
authors.forename: J D
authors.initials: JD
authors.lastname: Elashoff
authors.forename: E H
authors.initials: EH
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000379:methods* / Q000592:standards; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged