Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

Abstract

Background The concept that advanced surgical training can reduce or eliminate the learning curve for complex procedures makes logical sense but is difficult to verify and has not been tested for laparoscopic Roux-en-Y gastric bypass (LRYGB). We sought to determine if minimally invasive/bariatric surgery fellowship graduates (FGs) would demonstrate complication-related outcomes (CRO) equivalent to the outcomes achieved during their training experience under the supervision of experienced bariatric surgeons. Methods We compared CRO for the first 100 consecutive LRYGBs performed in practice by five consecutive minimally invasive/bariatric fellows at new institutions (total 500 cases) to CRO for the 611 consecutive LRYGBs performed during their fellowship training experience under the supervision of three experienced bariatric surgeons at the host training institution. Results The two patient groups did not differ demographically. The 18 types of major and minor complications identified after LRYGB did not differ among the five fellowship graduates. The mentors' CRO were compatible with published benchmark data. As compared with the training institution data, the overall incidence of complications for the combined experience of fellowship graduates did not differ statistically from that of the mentors. The fellowship graduates' early experience included zero nongastrojejunostomy leaks (0% versus 1.5%) and a low rate of anastomotic stricture (0.8% versus 3.0%), incisional hernia (1% versus 4.4%), bowel obstruction (0% versus 3%), wound infection (0.3% versus 3.1%), and gastrointestinal hemorrhage (0.2% versus 1.6%). The rate of gastrojejunostomy leak (1.8% versus 2.6%) and, most importantly, mortality (0.8% versus 0.7%) did not differ between the two groups. Conclusions Fellowship graduates achieved high-quality surgical outcomes from the very beginning of their postfellowship practices, which are comparable to those of their experienced mentors. These data validate the concept that advanced surgical training can eliminate the learning curve often associated with complex minimally invasive procedures, specifically LRYGB.

Minimally invasive video‐assisted total thyroidectomy: An easy to learn technique for skillful surgeons

“…18,19 The second and third qualifications were in our opinion very important. Like Ali et al, 7 we believe that skills acquired in other procedures as well as in virtual laparoscopic skill training are ''transferable'' to other more complex procedures, having an important influence on its learning curve. By using these qualifications, our participating surgeons mastered all the basic skills acquired during laparoscopic cholecystectomy, and all the basic and advanced skills acquired by virtual training.…”

“…7 The aim of the present prospective study was to define the learning curve for minimally invasive video-assisted total thyroidectomy (MIVATT) for last-year senior general surgery residents with experience in traditional thyroid and laparoscopic surgery.…”

Surgical Subspecialization: Escape Route for Surgeons or Added Benefit for Patients?

“…Evidence is mounting to show that higher surgeon volumes of specific cases lead to lower morbidity and mortality as well as shorter length of stay. [18][19][20][21][22][23] Even more compelling, recent research suggests that breast cancer patients and colon cancer patients are more likely to receive standard-of-care surgical treatment from trained subspecialists. [24][25][26] A shortage of 41 000 general surgeons is projected by 2025, 5 but in the face of data like these, perhaps we should worry more about improving the population's access to surgical subspecialists.…”

How to Train Surgical Residents to Perform Laparoscopic Roux‐en‐Y Gastric Bypass Safely

“…LRYGB is a technically challenging procedure, demanding advanced skills, such as intracorporeal bowel reconstruction and suturing. Arbitrarily, 50 to 150 procedures have been reported to eliminate the learning curve (2,(14)(15)(16)(17)(18)(19)(20)(21) . As a direct consequence of these expanding demands, a shortage of fully trained bariatric surgeons has emerged in many countries.…”

“…As a direct consequence of these expanding demands, a shortage of fully trained bariatric surgeons has emerged in many countries. So far, medical literature considering learning curves in bariatric surgery has mainly focussed on instructing already certified surgeons during bariatric fellowships (11,14,16,22,23) . However, scarce data are available considering incorporation of these techniques in regular surgical training of residents (2) .…”