title: Short-Term Outcomes of Laparoscopic Total Gastrectomy Performed by a Single Surgeon Experienced in Open Gastrectomy: Review of Initial Experience.
abstract: OBJECTIVE
  Laparoscopic total gastrectomy (LTG) is more complicated than laparoscopic distal gastrectomy, especially during a surgeon's initial experience with the technique. In this study, we evaluated the short-term outcomes of and learning curve for LTG during the initial cases of a single surgeon compared with those of open total gastrectomy (OTG).
  
  
  METHODS
  Between 2009 and 2013, 134 OTG and 74 LTG procedures were performed by a single surgeon who was experienced with OTG but new to performing LTG. Clinical characteristics, operative parameters, and short-term postoperative outcomes were compared between groups.
  
  
  RESULTS
  Advanced gastric cancer and D2 lymph node dissection were more common in the OTG than LTG group. Although the operation time was significantly longer for LTG than for OTG (175.7±43.1 minutes vs. 217.5±63.4 minutes), LTG seems to be slightly superior or similar to OTG in terms of postoperative recovery measures. The operation time moving average of 15 cases in the LTG group decreased gradually, and the curve flattened at 54 cases. The postoperative complication rate was similar for the two groups (11.9% vs. 13.5%). No anastomotic or stump leaks occurred.
  
  
  CONCLUSIONS
  Although LTG is technically difficult and operation time is longer for surgeons experienced in open surgery, it can be performed safely, even during a surgeon's early experience with the technique. Considering the benefits of minimally invasive surgery, LTG is recommended for early gastric cancer.
authors.affiliation: Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Song
authors.affiliation: Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea. ; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: An
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.affiliation: Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea. ; Brain Korea 21 PLUS Project for Medical Science, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
keywords: Laparoscopy; Learning curve; Stomach neoplasms; Total gastrectomy