Characterizing the Learning Curve for Laparoscopic Radical Hysterectomy
- 1 July 2011
- journal article
- research article
- Published by BMJ in International Journal of Gynecologic Cancer
- Vol. 21 (5), 930-935
- https://doi.org/10.1097/igc.0b013e3182157a44
Abstract
Total laparoscopic radical hysterectomy (TLRH) requires advanced skill in laparoscopy. We evaluated various objective measurements of surgical skill representing the learning curve throughout the first 2 years of implementation of TLRH at our institution. We also describe our technique of "buddy operating," where 2 surgeons combine referrals and operate together, thereby increasing the rate of skill acquisition. Charts were retrospectively reviewed for 45 patients undergoing TLRH and pelvic lymphadenectomy at the Hamilton Health Sciences from August 14, 2007, to August 14, 2009. A discriminant function analysis was used to describe the learning curve. χ² and t tests were used for discrete variables. The most predictive learning curve model divided the sample in two, with an accurate group assignment 72.1% of the time. After the first 23 procedures, operative time was significantly shorter (201.7 vs 176.6 min, P=0.02), estimated blood loss was significantly lower (355.7 vs 196.3 mL, P=0.01), the number of lymph nodes removed was significantly higher (11.5 vs 15.3, P=0.02), and hospital length of stay was significantly shorter (1.57 vs 0.14 days, P=0.002). There were nonsignificant trends toward decreasing intraoperative complications and postoperative morbidity. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy is an important procedure in gynecologic oncology. After a fellowship training program including laparoscopy, we demonstrate the learning curve improves after only 23 cases. This is shorter than previously reported and may be due to "buddy operating," a novel technique for reducing the learning curve in infrequently performed complex procedures.Keywords
This publication has 20 references indexed in Scilit:
- Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in patients with Ib1 stage cervical cancer: Analysis of surgical and oncological outcomeEuropean Journal of Surgical Oncology, 2009
- Total Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy in Early Stage Cervical CancerSurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2008
- The Outcome of Laparoscopic Radical Hysterectomy and Lymphadenectomy for Cervical Cancer: A Prospective Analysis of 295 PatientsAnnals of Surgical Oncology, 2008
- Laparoscopic total radical hysterectomy by the Pune technique: Our experience of 248 casesJournal of Minimally Invasive Gynecology, 2007
- Comparison of Total Laparoscopic and Abdominal Radical Hysterectomy for Patients With Early-Stage Cervical CancerObstetrics & Gynecology, 2007
- Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 proceduresSurgical Endoscopy, 2007
- Total laparoscopic radical hysterectomy and lymphadenectomy: The M. D. Anderson Cancer Center ExperienceGynecologic Oncology, 2006
- Total laparoscopic radical hysterectomy (type II-III) with pelvic lymphadenectomy in early invasive cervical cancerJournal of Minimally Invasive Gynecology, 2005
- Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot studyGynecologic Oncology, 2003
- Laparoscopic radical hysterectomy with paraaortic and pelvic node dissectionAmerican Journal of Obstetrics and Gynecology, 1992