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Training in the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons during 225 consecutive pancreaticoduodenectomies
Ann Hepatobiliary Pancreat Surg 2019 May;23(2):145-54
Published online May 31, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Daisuke Hashimoto1,2, Takaomi Okawa2, Fujio Matsumura2

Department of Gastroenterological Surgery, 1Kumamoto University Graduate School of Medical Sciences, Kumamoto, 2Omuta Tenryo Hospital, Omuta, Japan
Received June 29, 2018; Revised November 29, 2018; Accepted December 14, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: A board certification system has been established by the Japanese Society of Hepato-Biliary- Pancreatic Surgery (JSHBPS) for certifying surgeons who can perform high-level hepato-biliary-pancreatic surgeries safely. The aim of this study was to compare operative outcomes after pancreaticoduodenectomy performed by trainees, board-certified instructors, and expert surgeons of JSHBPS to determine the efficacy of education of trainees and operative safety.
Methods: From 2009 to 2017, 225 consecutive patients underwent pancreaticoduodenectomy. Operations were performed by trainees, instructors, or JSHBPS experts. Clinical course and postoperative outcomes were retrospectively evaluated.
Results: Twenty-two surgeons performed pancreaticoduodenectomy and two became expert surgeons. First, data of all patients who underwent pancreaticoduodenectomy (n=225) were analyzed. Significantly shorter median operating time and less median operative bleeding were documented in the experts’ group (428 min, 576 g, respectively) than in the trainees’ (498.5 min, 818 g, respectively) and instructors’ (557 min, 911 g, respectively) groups. Morbidity did not differ significantly between the three groups. Second, data of patients who underwent simple pancreaticoduodenectomy (n=130) were analyzed. Similarly, operating time was shorter and operative bleeding less in the experts’ group. With increasing their experiences, intraoperative bleeding by 2 surgeons became the expert surgeons decreased.
Conclusions: Surgeons judged experts by the JSHBPS board certification system achieve significantly shorter operating time and less operative bleeding during pancreaticoduodenectomy. In addition, PD performed by trainees has an acceptable incidence of postoperative complications. This is the first report which indicated the efficacy of education toward being the JSHPBS board-certified expert surgeon.
Keywords : Pancreaticoduodenectomy; Complication; Education


November 2019, 23 (4)