Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions

Terzi, Hasan; Biler, Alper; Demirtaş, Ömer; Güler, Ömer Tolga; Peker, Nuri; Kale, Ahmet

doi:10.1016/j.ijsu.2016.09.010

Cited by 51 publications

(41 citation statements)

References 24 publications

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“…This may result from the patient selection criteria, previous experience of the surgeon in simpler laparoscopic operations and/or difference in surgical technique (We do not routinely perform ureter dissection or perform cystoscopy routinely). However, the uterine weight or the history of pelvic/abdominal surgery, which may create bias, is comparable to the aforementioned studies except for the uterine weight in Terzi et al (10).…”

Section: Discussionmentioning

confidence: 51%

“…However, only a competent surgeon who reached the plateau of the learning curve can serve the virtues of laparoscopy to his/her patients safely. Reaching a plateau in the learning curve and gaining competency in laparoscopic procedures is generally measured by the number of cases operated with a (1) decreased operation time with a (2) acceptable perioperative complication rate, and (3) conversion to laparotomy (8,10,11). Despite the variables such as the difficulty of operations, motivation, and skill of the surgeon, pres-ence of supervision or mentorship, quality and expertise of assisting personnel and equipment quality defining the case number to complete the learning curve is important in the standardization of gynecologists' education.…”

Section: Discussionmentioning

confidence: 99%

“…But additional procedures were included in TLH in some of their cases (14). However, Terzi et al reported a longer learning curve in their retrospective series with two inexperienced gynecologists, up to 75 cases with shortening of operating time from 76 minutes to 68 min (10). They speculated that this might be linked to the selection of difficult cases, higher BMI, large uterine size and the absence of formal mentorship.…”

Section: Discussionmentioning

confidence: 99%

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The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

Bıyık

Albayrak²,

Keskin³

et al. 2020

Gynecol Obstet Reprod Med

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OBJECTIVES: Online education and certification programs which help most gynecologic surgeons to advance, improve and prove their skills. However, the benefits of such distant programs in terms of complication rate and operation time has not been evaluated so far. The aim of this study was to report the improvement of a single surgeon's learning curve in total laparoscopic hysterectomy who had no previous mentorship/fellowship education, working in a rural district hospital before and after the completion of a distant on-line education and certification program -Gynaecological Endoscopic Surgical Education and Assessment. STUDY DESIGN:Medical records of patients who underwent total laparoscopic hysterectomy between May 2015 and December 2018 were retrospectively reviewed and grouped based on the certification date of the surgeon, Group 1 before and Group 2 after certification. Groups were compared for variables that impact the learning curve (operation time, complications and conversion to laparotomy) RESULTS:Of the 57 women eligible for evaluation 30 had total laparoscopic hysterectomy in Group 1 and 27 had total laparoscopic hysterectomy in Group 2. BMI, number of vaginal/cesarean births, previous abdominal/pelvic surgeries, operation indications, uterine weight, adnexectomy, and adhesiolysis rates, transfusion requirements, and the decrease in hemoglobin before and after operation were similar between the groups (p>0.05). Operation time was significantly shorter in Group 2 (83 min vs.116 min, p<0.0001). CONCLUSION:Thirty total laparoscopic hysterectomy operations seem enough to reach a plateau in the learning curve for gynecologists working in rural areas with limited facilities who cannot afford lengthily and expensive fellowship/mentorship programs, after completing distant online certification programs.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

Bıyık

Albayrak²,

Keskin³

et al. 2020

Gynecol Obstet Reprod Med

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“…Furthermore, laparoscopic surgery has a steep and long learning curve. Some studies regarding learning curve of laparoscopic hysterectomy have concluded that 22 to 75 cases were required to reach plateau of learning curve (9)(10)(11). On the other hand, the threshold number has been reported as 20 to 50 cases for RTH (12,13).…”

Section: Discussionmentioning

confidence: 99%

Robotic Total Hysterectomy: Initial Experience in a Tertiary Center

Biler

Solmaz

Gökçü

et al. 2017

GMJ

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Objective: To examine our initial experience with robotic total hysterectomy and evaluate operation related outcomes. Materials and Methods: We retrospectively analyzed 16 consecutive patients who underwent robotic total hysterectomy between December 2015 and August 2016 in our clinic. Results: Robotic total hysterectomy was performed for benign indications in 13 (81.25%) patients, endometrial cancer in two patients (12.5%), microinvasive cervical cancer in one patient (6.25%). The mean age of patients was 48.7 ± 6.5 years, parity was 2.8 ± 1.7, body mass index was 28.2 ± 4.6 kg/m2, preoperative hemoglobin levels was 11.6 ± 1.0 g/dl, postoperative hemoglobin levels 10.3 ± 1.0 g/dl, operation time was 162.2 ± 39.4 minutes, docking time was 7.3 ± 3.3 minutes, console time was 147 ± 37.0 minutes, uterine weight was 178.8 ± 98.5 g and duration of hospital stay was 3.6 ± 1.8 days. Blood transfusion was administered to three patients in the postoperative period. One patient was converted to laparotomy because of poor visualization of pelvic structures by a large uterus. No intraoperative complication was encountered. Postoperative complications were limited to one patient with asthma who had fever on the first day following surgery. Conclusion:The results of robotic total hysterectomy is satisfactory for both patient and surgeon. Following the completion of the learning curve, robotic total hysterectomy could be an important alternative method for laparoscopic hysterectomy. However, the installation of robotic systems, operating and maintenance costs still remain as crucial limitations for the widespread use of robotic surgery.

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“…Studies have shown that gynaecological surgeons can perform LAVH/TLH securely during the learning curve. 13 All the studies on learning curve of laparoscopic hysterectomy were conducted in tertiary care teaching/university hospitals as per literature search. In view of the above, we conducted this retrospective study to analyze the learning curve and clinical efficacy of the art of laparoscopic hysterectomy in a zonal hospital setting (low resource setting) by a single surgeon with basic training in laparoscopy during residency.…”

Section: Introductionmentioning

confidence: 99%

Learning curve of laparoscopic hysterectomy in a zonal hospital setting: a retrospective analysis of 102 cases operated by a single surgeon

Kumar

Kapur

Bhat

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: The aim of this study was to analyse the learning curve and clinical efficacy of the art of laparoscopic hysterectomy in a zonal hospital setting.Methods: We conducted a retrospective analysis of 102 women who underwent laparoscopic hysterectomy (LAVH/ TLH) by a single surgeon after post-graduation for benign uterine pathology in a zonal hospital setting. They were divided into two groups of first 50 cases (Group I) and next 52 cases (Group II). The primary outcome was the learning curve of the operating gynaecologist in terms of reduction in duration of surgery, reduced perioperative complications, increasing percentage of TLHs with time.Results: 102 women underwent laparoscopic hysterectomy for the benign uterine pathology successfully. Surgical outcomes of laparoscopic hysterectomy in terms of mean operative time was 135 mins (Group I) vs 93 mins (Group II), estimated blood loss 255 ml (Group I) vs 140 ml (Group II), hospital stay 05 days (Group I) vs 03 days (Group II), duration of postoperative analgesia 07 days (Group I) vs 05 days (Group II). As the surgical experience increased, patients with bigger uterine size (>10-week size) were taken up for hysterectomy, percentage of TLH increased in Group II as compared to Group I (42.31% vs 18%), with decreasing complications and shorter recovery time.Conclusions: Laparoscopic hysterectomy (LAVH/ TLH) has a short learning curve and it's a feasible and beneficial surgical modality for treating benign uterine pathology even in a zonal hospital setting (low resource setting).

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Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions

Cited by 51 publications

References 24 publications

The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

Robotic Total Hysterectomy: Initial Experience in a Tertiary Center

Learning curve of laparoscopic hysterectomy in a zonal hospital setting: a retrospective analysis of 102 cases operated by a single surgeon

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