In Laparoscopic Myomectomy, Does a Caseload of 100 Patients During the Learning Curve Produce a Significant Improvement in Performance Measures?

Shah, Savan; Odejinmi, Jimi Funlayo; Agarwal, Nidheesh

doi:10.1007/s13224-015-0782-x

Cited by 9 publications

(3 citation statements)

References 23 publications

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“…Laparoscopic myomectomy is not commonly performed by all surgeons as it is estimated that it takes a surgeon to perform about a 100 of laparoscopic myomectomies for optimal outcomes and reduced complication rates. [7]. We believe the Robotic assistance can help bridge this gap and make the minimal access myomectomy accessible to larger population.…”

Section: Introductionmentioning

confidence: 99%

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

2022

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Uterine myomas are benign tumors frequently seen in women of reproductive age. Myomectomy remains a viable option for treating this condition in women who wish to preserve their uterus. We undertook this study to compare the peri-operative surgical outcomes of Robotic myomectomy (RM) with laparoscopic myomectomy (LM) in Indian patients of uterine myomas after the initial learning curve of RM was achieved. A retrospective chart review was performed for the patients who underwent RM or LM for the treatment of uterine myomas. A total of 177 patients; 116 in the RM group and 61 in the LM group were included in the study. The mean age in the RM and LM group was 34.31 ± 5.40 years and 33.54 ± 4.96 years respectively (p = .355). The mean total operative time was marginally more in RM group (127.37 ± 110.67 vs. 120.66 ± 44.27, p = .650) but the difference was not statistically signi cant. Patients in the RM group had signi cantly less blood loss (115.43 ± 79.43 vs. 340.98 ± 453.9 ml, p = <.0001), hospital stay (1.28 ± 0.49 vs. 1.92 ± 1.05 days, p = <.0001), requirement of blood transfusion (93.97% vs. 81.97%, p = .031) and requirement of intravenous (IV) analgesia (41.38% vs. 34.43%, p = .019) as compared to the patients in the LM group. The Robotic myomectomy signi cantly reduces blood loss, the duration of hospital stay, and requirement of blood transfusions and IV analgesia as compared to the laparoscopic myomectomy.

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Section: Introductionmentioning

confidence: 99%

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

2022

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“…The decision to proceed with LM should reflect the surgeon's experience and skill. LM is thought to have a particularly steep learning curve because of its technical difficulty (especially advanced intracorporeal suturing), long operating times and the risk of conversion to laparotomy . LM demands meticulous laparoscopic haemostasis and precise closure of the myometrium.…”

Section: Patient Selectionmentioning

confidence: 99%

Laparoscopic myomectomy: a review of alternatives, techniques and controversies

Bryant‐Smith

2018

The Obstetric & Gynaecologis

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Key content Laparoscopic myomectomy (LM) is considered to be particularly technically difficult because it requires advanced intracorporeal suturing. LM involves a wide continuum of surgical difficulty; surgeons must be self‐aware of both their skill‐set and their limitations when selecting appropriate patients for this surgery. The greater a woman's age, the less there is to be gained by preserving her future fertility and the greater the risk of leiomyosarcoma. Hysterectomy should be considered when fertility is no longer desired or feasible. When asking a patient to give consent for LM, the following risks must be mentioned: parasitic myomata and disseminated peritoneal leiomyomatosis, and potentially upstaging an occult malignancy (such as leiomyosarcoma). There is currently no preoperative test to definitively exclude leiomyosarcoma. Learning objectives To understand the importance of thorough preoperative counselling before LM, including the potential risks of intracorporeal morcellation. To understand the key steps involved in performing an LM. Ethical issues The potential benefits of a laparoscopic versus open myomectomy must be considered; for example, does the worsened prognosis in women with unsuspected leiomyosarcoma, inadvertently morcellated, outweigh adverse outcomes in patients who undergo open myomectomy? Since in‐bag morcellation remains an experimental technique, its possible benefits and long‐term outcomes are yet to be established.

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“…Despite disparate training regimens, the value associated with increased surgical exposure remains largely uncharacterized, which impairs the ability of educators to make evidence‐based decisions regarding surgical curriculum. Surgical case numbers have been shown in human medicine to be inconsistently associated with competence, although learning curves for specific procedures have been used for assessment of proficiency in human surgery and have recently been examined in veterinary medicine for this purpose . Learning curves are helpful in characterizing the overall arc of training but may not be helpful for goal setting in preliminary experiences.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting the duration of anesthesia and surgery of canine and feline gonadectomies performed by veterinary students in a year‐long preclinical surgery laboratory

2019

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Objective: To determine factors affecting the duration of canine and feline gonadectomies performed by second-year veterinary students. Study design: Retrospective study of 1288 gonadectomies. Sample population: One hundred ninety-four second-year veterinary students in a 24-week veterinary surgical teaching laboratory. Methods: Surgical and anesthetic records were analyzed and arranged by primary surgeon in chronological order. Species, sex, weight, body condition score, occurrence of an intraoperative complication, and order of sequential cases in the year performed by the primary surgeon were assessed for their influence on anesthesia, surgery, and preparation times. Results: Each student performed an average of 6.6 (±1.08) gonadectomies over 24 weeks. Dogs, females, increasing weight, intraoperative complications, and earlier sequential cases were associated with longer duration of surgery and anesthesia. These factors accounted for 50% and 59% of anesthetic and surgical time variance, respectively. The rate of intraoperative complications did not change across time but was higher during canine ovariohysterectomies. Duration of anesthesia and surgery for canine orchiectomy decreased by 29 and 21 minutes, respectively, and for canine ovariohysterectomy decreased by 16 and 12 minutes, respectively, over 24 weeks without reaching a learning plateau. Conclusion: Species, sex, weight, complications, and earlier sequential cases influenced duration of anesthesia and surgery. Clinical significance: By establishing a baseline for duration of student-performed surgeries and describing the relative impact of factors influencing duration, students and educators may be able to set goals for student improvement during teaching laboratories.

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In Laparoscopic Myomectomy, Does a Caseload of 100 Patients During the Learning Curve Produce a Significant Improvement in Performance Measures?

Cited by 9 publications

References 23 publications

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

Laparoscopic myomectomy: a review of alternatives, techniques and controversies

Factors affecting the duration of anesthesia and surgery of canine and feline gonadectomies performed by veterinary students in a year‐long preclinical surgery laboratory

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