Lee Boram, Lee Yoon Taek, Park Young Suk, Ahn Sang-Hoon, Park Do Joong, Kim Hyung-Ho
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Gastric Cancer. 2018 Jun;18(2):182-188. doi: 10.5230/jgc.2018.18.e20. Epub 2018 Jun 28.
Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG.
A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group.
Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%:8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%:38.5%). The operative time of surgeon B significantly decreased after 30 cases (157.8±38.4 minutes vs. 118.1±34.5 minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases (160.8±51.6 minutes vs. 173.3±35.2 minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of <25 kg/m (<25 kg/m:≥25 kg/m, 159.3±41.7 minutes: 194.25±81.1 minutes; P=0.001).
Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of <25 kg/m was found to be a favorable factor for SPDG.
尽管有几篇关于单孔腹腔镜远端胃切除术（SPDG）的报道，但文献中尚未描述对其学习曲线的分析。本研究的目的是调查SPDG的有利因素并分析SPDG的学习曲线。
纳入2011年11月至2015年12月期间进行的125例SPDG病例。所有手术均由2名外科医生（外科医生A和外科医生B）完成。采用移动平均法定义学习曲线。所有病例按顺序分为每组10例，并从每组中提取平均手术时间和估计失血量数据。
外科医生A进行了68例手术（男女比例为91.1%:8.82%），外科医生B进行了57例手术（男女比例为61.4%:38.5%）。外科医生B在完成30例手术后手术时间显著缩短（157.8±38.4分钟对118.1±34.5分钟，P = 0.003）；外科医生A在约30例手术前后手术时间没有显著缩短（160.8±51.6分钟对173.3±35.2分钟，P = 0.6）。亚组分析显示，体重指数（BMI）<25 kg/m²的患者手术时间显著缩短（<25 kg/m²:≥25 kg/m²，159.3±41.7分钟:194.25±81.1分钟；P = 0.001）。
虽然外科医生A的手术时间没有显著缩短，但外科医生B在进行30例SPDG手术后达到了学习曲线。发现BMI<25 kg/m²是SPDG的一个有利因素。
