Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy.
BACKGROUND
To assess the probability of conversion of a laparoscopic myomectomy to an open procedure, we only found the score developed by Dubuisson et al. (2001) based on four preoperative risk factors. Routinely this score is not appropriate, as realized by the most skilled laparoscopic surgeons.


METHODS
The aim of this study was to identify the preoperative factors affecting the risk of conversion in data collected in different centers among a population of surgeons at the beginning of their experience in laparoscopic myomectomy. We collected preoperative clinical and ultrasonography data for all laparoscopic myomectomies performed in 11 hospital centers between January 1996 and December 2000. Data were available for 116 patients. Multiple logistic regression was use to develop a simple predictive model based on available preoperative risk factors of laparoconversion.


RESULTS
We encountered 33 laparoconversions (28%) compared to an expected number of 7.8 using Dubuisson's score. We confirmed the importance of two of the four risk factors in Dubuisson's model: biggest myoma size at ultrasonography (increased 1 mm) (OR: 1.06) and intramural type (OR: 3.25) of the dominant myoma. However, we also identified another risk factors: surgeon's experience (OR: 0.15). Simple score was calculated and used to provide an estimated risk of conversion.


CONCLUSIONS
Our model is a useful tool to predict laparoconversion for surgeons beginning in laparoscopic myomectomy. Ultrasound evaluation is essential before performing the procedure. Skilled surgeons in laparoscopy and in laparoscopic myomectomy must help their trainees during their learning curve in order to reduce laparoconversion rate.
Département de Gynécologie, Obstétrique, Médecine foetale et Reproduction humaine, Centre Hospitalier Universitaire Hôpital Bretonneau, Tours, France. marret@med.univ-tours.fr
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H
Marret
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Chevillot
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B
Giraudeau
D000328:Adult; D005260:Female; D005544:Forecasting; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000601:surgery*; D008962:Models, Theoretical; D009215:Myometrium / Q000601:surgery; D011361:Professional Competence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*