The Clinical Safety of Performing Laparoscopic Gastrectomy for Gastric Cancer by Trainees after Sufficient Experience in Assisting

Laparoscopic gastrectomy (LAG) is increasingly performed to treat gastric cancer. However, the procedure remains complicated, and an optimal system for educating clinicians about LAG has not been established. Our training system centers on understanding the anatomical appearance under laparoscopy and the standardized steps of LAG, including the roles of the scopist and the assistant. The trainees participated in LAG procedures as a scopist and an assistant in 30-35 cases, before conducting their first LAG case. The data of 788 consecutive patients with early gastric cancer who underwent LAG were also reviewed. During the study period, nine trainees performed a total of 215 LAG (27.3 %) with trainers, while 563 LAG were conducted by the two trainers (71.4 %). The surgical outcomes including operative time, blood loss, and retrieval of lymph nodes were almost equivalent for both the trainers and the trainees. The total experience among the trainees as scopist and as first assistant was 45.0 and 41.4 cases, respectively, and the trainees had experienced 33.8 cases as a scopist and 35.3 cases as an assistant before they performed their first LAG as an operator. After commencing experience as an operator, the average operation time of the trainees reached that of the trainers within six cases and their learning curve reached a plateau. Our training system based on attaining sufficient experience as an assistant and scopist in the simulation of a LAG procedure was effective for ensuring clinical safety for LAG performed by a trainee with experienced surgeons.