Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis

The application of laparoscopic gastrectomy in management of gastric cancer is being propagated rapidly. Training and education play important role during this process. The purpose of this study is to define the learning curve of laparoscopic gastrectomy to obtain an insight into this training process. All 362 cases of laparoscopic gastrectomy from January 1998 to July 2007 were enrolled and divided into 12 groups of 30 cases each in time sequence. The learning curve was defined with the split group method. Laparoscopic distal gastrectomy was extracted from the 12 groups and the means of operation time and intraoperative blood loss were compared to define the learning curve. Then general data and variables including occurrence of systematic inflammatory response syndrome (SIRS), complications, and conversion to open surgery were compared among the phases of learning curve. A three-phase learning curve of laparoscopic gastrectomy was defined from the laparoscopic distal gastrectomy-based analysis, which included a training phase for the first 120 cases of operation, an intermediate phase for the following 90 cases, and a well-developed phase for the last 152 cases. Learning was considered to be complete after 60-90 operations in the training phase. For most variables, the differences among three phases were statistically significant except for the rate of complications. There was a significant learning curve, composed of three phases. Experience of about 60-90 cases of operation was required for completion of learning.