title: The benefits of standardizing the operative procedure for the assistant in laparoscopy-assisted gastrectomy for gastric cancer.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Tokyo, Japan. naoki.hiki@jfcr.or.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Testsu
authors.initials: T
authors.lastname: Fukunaga
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Ohyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
authors.forename: Hidemaro
authors.initials: H
authors.lastname: Yoshiba
authors.forename: Kyoko
authors.initials: K
authors.lastname: Nohara
authors.forename: Harutaka
authors.initials: H
authors.lastname: Inoue
authors.forename: Tetsuichiro
authors.initials: T
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016063:Blood Loss, Surgical / Q000503:physiopathology; D002983:Clinical Competence / Q000592:standards; D005260:Female; D005743:Gastrectomy / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008197:Lymph Node Excision / Q000592:standards; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010823:Physician Assistants / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013552:Swine; D013996:Time and Motion Studies; D014630:Vagus Nerve / Q000601:surgery