title: Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach.
abstract: OBJECTIVE
  Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon.
  
  
  METHODS
  Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups.
  
  
  RESULTS
  MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity.
  
  
  CONCLUSIONS
  This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon.
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Yung Hun
authors.initials: YH
authors.lastname: You
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Yoo Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Dae Ho
authors.initials: DH
authors.lastname: Ahn
keywords: Beginner surgeon; Laparoscopy; Minimally invasive surgical procedures; Robotics; Stomach neoplasms
references.citation: J Gastric Cancer. 2010 Dec;10(4):241-6
references.pmid: 22076192
references.citation: Surg Endosc. 2014 May;28(5):1563-70
references.pmid: 24380984
references.citation: Gastric Cancer. 2011 Jun;14(2):113-23
references.pmid: 21573742
references.citation: J Clin Oncol. 2014 Mar 1;32(7):627-33
references.pmid: 24470012
references.citation: Surg Endosc. 2012 Jun;26(6):1548-53
references.pmid: 22170319
references.citation: J Natl Compr Canc Netw. 2013 May 1;11(5):531-46
references.pmid: 23667204
references.citation: Ann Oncol. 2010 May;21 Suppl 5:v50-4
references.pmid: 20555102
references.citation: Surg Endosc. 2011 Dec;25(12):3939-45
references.pmid: 21656069
references.citation: Ann Surg. 2007 Jan;245(1):68-72
references.pmid: 17197967
references.citation: J Gastric Cancer. 2014 Jun;14(2):87-104
references.pmid: 25061536
references.citation: Arch Surg. 2011 Sep;146(9):1086-92
references.pmid: 21576595
references.citation: Surg Endosc. 2009 Jun;23(6):1204-11
references.pmid: 19263147
references.citation: Ann Surg. 2010 Mar;251(3):417-20
references.pmid: 20160637
references.citation: Eur J Surg Oncol. 2007 Apr;33(3):314-9
references.pmid: 17174511
references.citation: J Surg Oncol. 2012 Mar;105(3):297-303
references.pmid: 21952834
references.citation: J Am Coll Surg. 2008 Aug;207(2):e6-11
references.pmid: 18656040
references.citation: J Am Coll Surg. 2002 Aug;195(2):284-7
references.pmid: 12168979
references.citation: World J Gastroenterol. 2005 Dec 21;11(47):7508-11
references.pmid: 16437724
references.citation: Eur Urol. 2006 Mar;49(3):491-8; discussion 499-500
references.pmid: 16359780
references.citation: Ann Surg. 2004 Aug;240(2):205-13
references.pmid: 15273542
references.citation: Eur J Surg Oncol. 2014 Oct;40(10):1346-54
references.pmid: 24080199
references.citation: Surg Endosc. 2012 Jan;26(1):60-7
references.pmid: 21789643