title: Total laparoscopic hysterectomy: the Brisbane learning curve.
abstract: BACKGROUND
  Total laparoscopic hysterectomy (TLH) is becoming more commonly used for gynaecological malignancies.
  
  
  OBJECTIVE
  To describe our experience with TLH since its introduction to our tertiary referral centre for gynaecological cancer in 2003.
  
  
  METHODS
  Retrospective analysis of the first 120 consecutive cases of TLH performed at our gynaecological cancer centre. Patients were divided into the first, second and third group of 40 patients. Operating time, estimated blood loss, hospital stay, conversion to laparotomy and intra- and postoperative morbidity were evaluated.
  
  
  RESULTS
  The three groups were similar with regard to baseline characteristics. For the entire group the mean hospital stay was 2.4 +/- 1.4 days and eight of 120 patients (6.6%) required conversion to laparotomy. Operating time, estimated blood loss and intraoperative morbidity were similar among the three groups. Postoperative morbidity was highest (25%) in the middle one-third of the patients (P = 0.022). The percentage of pelvic lymph node dissections increased from 2.5% in the first one-third of patients to 27.5% in the final one-third of patients (P = 0.003).
  
  
  CONCLUSIONS
  TLH can be established safely in a tertiary gynaecological cancer referral centre.
authors.affiliation: Queensland Centre for Gynaecological Cancer, Royal Women's and Brisbane Hospital, Brisbane, Queensland, Australia.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Garrett
authors.forename: Marcelo Carraro
authors.initials: MC
authors.lastname: Nascimento
authors.forename: James L
authors.initials: JL
authors.lastname: Nicklin
authors.forename: Lewis C
authors.initials: LC
authors.lastname: Perrin
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D002983:Clinical Competence; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome