Learning Laparoscopic-Assisted Hysterectomy
- 1 August 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 104 (2), 308-313
- https://doi.org/10.1097/01.aog.0000132806.46344.05
Abstract
OBJECTIVE: The aim of this study was to evaluate the factors considered for proficiency and to estimate the number of procedures needed to achieve competence in laparoscopic-assisted vaginal hysterectomy in a teaching hospital. METHODS: The length of the learning curve, duration of surgery, change of hemoglobin (in grams per liter), conversion rate, and intra- and postoperative complications were evaluated. Cases were analyzed according to the order for the individual surgeon. RESULTS: Thirty-three surgeons performed 929 laparoscopic-assisted vaginal hysterectomies during the study period. Analyzing the duration of surgery and rate of complications, we decided on a cutoff of 30 cases. Eight surgeons with more than 30 cases performed 668 laparoscopic-assisted vaginal hysterectomies. Their initial 30 cases (group A, the first 30 cases) were compared with their subsequent cases (group B, cases 31 and after). Patient age, body mass index, and uterine weight did not differ between the groups. The intraoperative complication rate dropped from 4.2% to 0.5% (P = .001), hemoglobin drop decreased from −0.8 ± 0.9 g/L to −0.5 ± 1.0 g/L (P = .002), and postoperative complications dropped from 12.9% to 7.0% (P = .017). The duration of surgery was also shorter (148.8 ± 45.4 minutes versus 125.1 ± 46.5 minutes), but this difference was taken from the results of 1 surgeon. CONCLUSION: A learning experience of 30 laparoscopic-assisted vaginal hysterectomies was necessary in our institution to reach a low level of complications. Duration of the surgical procedure was not an adequate study endpoint to assess a learning effect. LEVEL OF EVIDENCE: II-3Keywords
This publication has 14 references indexed in Scilit:
- Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vesselsSurgical Endoscopy, 2003
- Prospective randomized comparison of laparoscopic-assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200 gSurgical Endoscopy, 2001
- Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter studyAmerican Journal of Obstetrics and Gynecology, 1999
- The effect of the learning curve on the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomyActa Obstetricia et Gynecologica Scandinavica, 1999
- An assessment of the learning curve for laparoscopic and total laparoscopic hysterectomyGynaecological Endoscopy, 1998
- A Multicenter Randomized Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Abdominal Hysterectomy in Abdominal Hysterectomy CandidatesObstetrics & Gynecology, 1998
- Laparoscopically assisted vaginal hysterectomy for non-malignant disease of the uterus. Report on a personal series of 126 casesEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 1996
- A randomised prospective trial comparing laparoscopic and abdominal hysterectomyBJOG: An International Journal of Obstetrics and Gynaecology, 1996
- A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo‐oophorectomyBJOG: An International Journal of Obstetrics and Gynaecology, 1994
- Comparison of laparoscopically assisted vaginal hysterectomy and bilateral salpingo‐ophorectomy with conventional abdominal hysterectomy and bilateral salpingo‐ophorectomyBJOG: An International Journal of Obstetrics and Gynaecology, 1993