Geubbels Noëlle, de Brauw L Maurits, Acherman Yair I Z, van de Laar Arnold W J M, Wouters Michel W J M, Bruin Sjoerd C
Department of Metabolic and Bariatric Surgery, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands,
Obes Surg. 2015 Aug;25(8):1417-24. doi: 10.1007/s11695-014-1538-x.
The learning curve of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has been well investigated. The learning curve is defined by complications and/or by duration of surgery (DOS). Previous studies report an inverse relationship between patient outcome and patient volume. In this study, we investigate whether the learning curve of preceding bariatric surgeons is of additional influence for surgeons who start to perform LRYGB in the same centre.
We retrospectively analysed the records of all 713 consecutive primary LRYGB patients operated in our centre from December 2007 until July 2012. Surgeon 1 and 3 had previous laparoscopic bariatric experience whilst Surgeon 2 and 4 had not. We stratified the data between the four surgeons with different levels of experience and in a chronology of 50 cases.
Sixty-seven (9.4 %) complications occurred in the study period. Surgeon 1 had more complications occurring within the first 50 cases than Surgeon 4 (10 versus 1, p < 0.05). There was no difference in complication rate between groups of 50 consecutive cases. None of the patients died. DOS decreased for every consecutive surgeon, irrespective of their experience. The learning curve defined by DOS was steepest for Surgeon 1, followed by Surgeon 2, 3 and 4.
In this study, we show that the learning curve of the preceding surgeon positively influences the learning curve of latter surgeons, irrespective of their experience. Therefore, the 'preceding surgeon factor' should be taken in account in addition to volume requirements when starting new bariatric facilities.
腹腔镜Roux-en-Y胃旁路术（LRYGB）的学习曲线已得到充分研究。学习曲线由并发症和/或手术时长（DOS）来定义。既往研究报道患者结局与患者数量之间呈负相关。在本研究中，我们调查了在同一中心开始实施LRYGB的外科医生，其之前减重外科医生的学习曲线是否会产生额外影响。
我们回顾性分析了2007年12月至2012年7月在本中心连续接受初次LRYGB手术的713例患者的记录。外科医生1和3有腹腔镜减重手术经验，而外科医生2和4没有。我们根据经验水平将数据在四位外科医生之间进行分层，并按50例的时间顺序排列。
研究期间发生了67例（9.4%）并发症。外科医生1在前50例手术中出现的并发症比外科医生4多（10例对1例，p < 0.05）。连续50例患者组之间的并发症发生率没有差异。没有患者死亡。无论经验如何，每位连续的外科医生的手术时长均有所减少。由手术时长定义的学习曲线，外科医生1最陡，其次是外科医生2、3和4。
在本研究中，我们表明先前外科医生的学习曲线对后来外科医生的学习曲线有积极影响，无论其经验如何。因此，在开设新的减重手术机构时，除了考虑手术量要求外，还应考虑“先前外科医生因素”。
