Surgical assessment system reflexes and facilitates the developing the surgical skills of trainees for the Laparoscopic Distal Gastrectomy

Abstract

Background: To assess laparoscopic distal gastrectomy (LDG) for gastric cancer (GC), the Japanese Operative Rating Scale (JORS) for LDG has been developed. This study evaluated the learning curve of the initial experience of LDG for GC using JORS-LDG. Methods: Thirty-one cases of LDG were performed by a trainee. The trainee and an instructor scored the surgical performance using JORS-LDG immediately after LDG. The 31 cases were evenly divided into early phase (EP), middle phase (MP), and late phase (LP). Results: The trainee successfully completed all cases of LDG without any complications. There were also no severe postoperative complications with Clavien–Dindo classification grade III or higher. The average JORS-LDG points were stable after 24 cases of experience in the CUSUM analysis. The median JORS-LDG points in EP were significantly lower than those in LP (EP: MP: LP = 43.5: 44.3: 45.5, P = 0.02). In operative data, procedure time, bleeding, and the drain fluid amylase level were correlated with the JORS-LDG points. Conclusion: The JORS-LDG scoring system is a practical tool to evaluate surgical performance in the initial LDG experience.