Usefulness of a stepwise training program for laparoscopic gastrectomy.
INTRODUCTION
Laparoscopic gastrectomy (LG) is a complicated procedure with a long learning curve. This study was performed to investigate the usefulness of our stepwise training program for LG for improving the quality of the surgery.


METHODS
The stepwise training method comprised the following four steps: (1) basic training using a dry box and checking by mentors; (2) advanced training, including the use of animals and cadavers; (3) clinical experience, including standardization and preoperative three-dimensional simulation; and (4) self-assessment and feedback. In total, 153 patients who underwent curative gastrectomy for gastric cancer were included in this study.


RESULTS
The operative time gradually decreased for both laparoscopic distal gastrectomy (LDG) (2013, 395 minutes; 2017, 278 minutes; P < .001; ρ = -0.68) and laparoscopic total gastrectomy (LTG) (2013, 476 minutes; 2017, 319 minutes; P < .001; ρ = -0.56). The blood loss volume gradually decreased for both LDG (2013, 43.0 mL; 2017, 18.6 mL; P < .005; ρ = -0.30) and LTG (2013, 143.8 mL; 2017, 13.5 mL; P < .005; ρ = -0.41).


CONCLUSIONS
Our stepwise training program contributes to reduce operation time and blood loss in LG.
['Nishi|Masaaki|M|https://orcid.org/0000-0003-3845-457X', 'Shimada|Mitsuo|M|', 'Yoshikawa|Kozo|K|https://orcid.org/0000-0001-9751-1007', 'Tokunaga|Takuya|T|', 'Kashihara|Hideya|H|https://orcid.org/0000-0003-0739-2126', 'Takasu|Chie|C|', 'Yoshimoto|Toshiaki|T|https://orcid.org/0000-0003-0383-0504', 'Iwahashi|Shoko|S|']
stepwise training laparoscopic gastrectomy gastric cancer