Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital.
OBJECTIVE
To prospectively analyze the learning curve of laparoscopic-assisted vaginal hysterectomy (LAVH) in a surgical team and evaluate if length of surgery can be reduced safely.


METHODS
Prospective observational study (Canadian Task Force classification II-2).


METHODS
Department of obstetrics and gynecology in a university-affiliated hospital.


METHODS
One hundred and sixty consecutive women undergoing LAVH performed between January 1, 1998 and April 30, 2001.


METHODS
LAVH (AAGL Classification System for Laparoscopic Hysterectomy III-B-3).


RESULTS
The primary parameter evaluated was length of surgery. Patients were grouped in cohorts of 10, in order to perform a time curve that would assist us in evaluation of the learning process. Once the plateau was reached, we evaluated the process before and after this plateau (groups 1 [learning stage] and 2 [second stage], respectively). Average length of surgery was 126 minutes (range, 60-260). Length of surgery was 138 minutes (range, 75-260) in the learning stage (first 80 cases) and 112 minutes (range, 60-225) in the second stage (p <.0001). Total rate of complications was 11.6%. There were three major complications, and they occurred before the plateau. There were 15 minor complications (9.67%), 8 during the first stage and 7 in the second stage, (p =.9; NS). A second learning curve excluding LAVH with associated surgeries was obtained. The average length of surgery for the first stage was 133 minutes (range, 75-205) and 102 minutes for the second stage (range, 60-130) (p >.0001).


CONCLUSIONS
Analysis of the learning curve demonstrated that the length of surgery in LAVH could be reduced without increasing the number of complications.
Kreiker
Gustavo Luis
GL
Department of Obstetrics and Gynecology, Hospital Privado Centro Médico de Córdoba, Argentina.
Bertoldi
Ariel
A
Larcher
José Sad
JS
Orrico
Guillermo Ruiz
GR
Chapron
Charles
C
D000328:Adult; D000368:Aged; D001118:Argentina; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000193:education* / Q000379:methods; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors