The effect of the learning curve on the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomy.
BACKGROUND
Hysterectomy is the commonest elective major gynecological operation and the laparoscopic approach is increasingly an option. We evaluated the influence of the learning curve on the duration of surgery and also the peri-operative complications.


METHODS
A retrospective study of the case records of patients who had laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy between August 1993 and July 1997.


RESULTS
Over a four year period 86 cases of laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy were performed; the main indication being menstrual disorders. The mean duration of surgery was 116 minutes. There was a significant difference in the mean duration of surgery between the first two years (123 minutes) and the last two years (110 minutes) (p<0.02). The difference in the mean duration of surgery performed either by consultants or senior registrars under supervision (115 versus 116 minutes) was not significant (p>0.05). The overall complication rate was 16% with a majority (85%) occurring in the first two years of the study period. Three cases (5%) were converted to conventional abdominal hysterectomy. After the initial learning phase there was a significant reduction in the complication rates.


CONCLUSIONS
The impact of the learning curve on the duration of surgery is gradual. The perceived duration of surgery should not be a disincentive for senior trainees provided they are already proficient in minor laparoscopic surgery, cases are suitably selected and adequate supervision is provided.
Ikhena
S E
SE
Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, England, United Kingdom.
Oni
M
M
Naftalin
N J
NJ
Konje
J C
JC
D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D007431:Intraoperative Complications; D010535:Laparoscopy