title: Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Privado Centro Médico de Córdoba, Argentina.
authors.forename: Gustavo Luis
authors.initials: GL
authors.lastname: Kreiker
authors.forename: Ariel
authors.initials: A
authors.lastname: Bertoldi
authors.forename: José Sad
authors.initials: JS
authors.lastname: Larcher
authors.forename: Guillermo Ruiz
authors.initials: GR
authors.lastname: Orrico
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: 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