title: Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer.
abstract: OBJECTIVE
  To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer.
  
  
  METHODS
  The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated.
  
  
  RESULTS
  After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (<200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups.
  
  
  CONCLUSIONS
  Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Min-Chan
authors.initials: MC
authors.lastname: Kim
authors.forename: Ghap-Joong
authors.initials: GJ
authors.lastname: Jung
authors.forename: Hyung-Ho
authors.initials: HH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D004502:Education, Medical, Continuing; D005260:Female; D005743:Gastrectomy / Q000193:education* / Q000379:methods / Q000592:standards; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D008197:Lymph Node Excision / Q000193:education* / Q000379:methods / Q000592:standards; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000592:standards; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*