Abstract
Background
A learning curve (LC) is a graphic display of the number of consecutive procedures performed necessary to reach competence and is defined by complications and duration of surgery (DOS). There is little evidence on the LC of surgical residents in bariatric surgery. Aim of the study is to evaluate whether the laparoscopic Roux-en-Y gastric bypass (LRYGB) can be safely performed by surgical residents, to evaluate the LC of surgical residents for LRYGB and to assess whether surgical residents fit in the LC of the bariatric center which has been established by their proctors.
Methods
Records of all 3389 consecutive primary LRYGB patients, operated between December 2007 and January 2016 in a bariatric center-of-excellence in Amsterdam, were reviewed. Differences in DOS were assessed by means of a linear regression model. Differences in complications (classified as Clavien-Dindo ≥ 2) were evaluated with the χ 2 or the Fisher exact test. Cases were clustered in groups of 70 for comparison and reported for residents with ≥70 cases as primary surgeon.
Results
Four surgeons (S1-4) and three residents (R1-3) performed 2690 (88.2%) and 361 (11.8%) of 3051 LRYGBs, respectively. Median (IQR) DOS was 52.0 (42.0–65.0) min for S1-4 versus 53.0 (46.0–63.0) min for R1-3 (p = 0.52). The LC of R1-3 in their first 70 cases (n = 210) differs significantly from the individual (n = 70) LCs of surgeon 1, 2, and 3, with remarkably shorter DOS for the residents (adjusted p < 0.0001; p < 0.001 and p = 0.0002, respectively) and the same amount of surgical complications 5.1% (137/2690) for S1-4 versus 3.0% (11/361) for R1-3 (p = 0.089).
Conclusion
Laparoscopic Roux-en-Y gastric bypass can be safely performed by surgical residents under supervision of experienced bariatric surgeons. Surgical residents benefit from the experience of their proctors and they fit faultlessly in the LC of the surgical team, as set out by their proctors in a large bariatric center-of-excellence.
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Acknowledgements
The authors would like to acknowledge A. Amarti, Dr. J.K. de Bakker and Dr. G.F. Giannakopoulos for their contributions to this paper.
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A. van Rijswijk, D.E. Moes, N. Geubbels, B.A. Hutten, Y.I.Z. Acherman, A.W. van de Laar, M. de Brauw, S.C. Bruin declared that they have no conflicts of interest or financial ties to disclose.
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The Medical Ethics Committee has waived ethical approval of this study.
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All patients within the used database have agreed upon, and signed for, the anonymous use of their data for scientific use before they underwent bariatric surgery at MC Slotervaart.
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Anne-Sophie van Rijswijk and Daan E. Moes contributed equally to the paper and should be considered co-first authors.
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van Rijswijk, AS., Moes, D.E., Geubbels, N. et al. Can a laparoscopic Roux-en-Y gastric bypass be safely performed by surgical residents in a bariatric center-of-excellence? The learning curve of surgical residents in bariatric surgery. Surg Endosc 32, 1012–1020 (2018). https://doi.org/10.1007/s00464-017-5779-3
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DOI: https://doi.org/10.1007/s00464-017-5779-3