Early experience and learning curve of solo single-incision distal gastrectomy for gastric cancer: a review of consecutive 100 cases.

BACKGROUND

Single-incision distal gastrectomy (SIDG) is technically difficult due to limited range of motion and unstable field of view. Solo surgery using a passive scope holder may be the key in allowing SIDG to be safer and efficient. We report our initial 100 cases of, to what we know, the world's first solo SIDG, and calculate the learning curve.

METHODS

Prospectively collected database of 100 patients clinically diagnosed as gastric cancer who underwent solo SIDG from October 2013 until July 2016 was analyzed. All the operations were held by a single surgeon with no assistants. A passive laparoscopic scope holder was used to fix the field of view.

RESULTS

The mean operation time was 120.6 ± 30.2 min, and the average estimated blood loss was 33.5 ± 55.7 ml. Average body mass index was 23.4 ± 2.9 kg/m. The median hospital stay was 5 (4-14) days, and the mean number of retrieved lymph nodes was 56.0 ± 22.8. There was no conversion to multiport or open surgery. Early complication of Clavien-Dindo grade III or more was 3%. Learning curve was calculated on operation time, and showed that an experienced surgeon in SIDG required 20 cases or less in stabilizing the operation time for solo SIDG.

CONCLUSIONS

Solo SIDG seems to be feasible and safe. The stable field of view created by a scope holder provides a favorable environment for a finer and more consistent operation. In addition, manpower can also be saved without affecting the quality of surgery.