title: Learning and teaching advanced laparoscopic procedures: do alternating trainees impair a laparoscopic surgeon's learning curve?
abstract: OBJECTIVE
  In this study we investigated whether teaching advanced laparoscopic procedures like laparoscopic-assisted surgical staging (LASS) for endometrial cancer negatively affects the learning curve of the attending surgeon.
  
  
  METHODS
  Retrospective study (Canadian Task Force classification II-3.)
  
  
  METHODS
  Department of Obstetrics and Gynecology, University of Arizona, Tucson.
  
  
  METHODS
  One hundred twenty-four patients undergoing LASS for endometrial cancer at our institution from 1992 through 2004 were included for analysis.
  
  
  METHODS
  Cases were classified into 3 groups. Group A comprised the initial learning phase where 2 attending gynecologic oncologists used other faculty as assistants (first 30 cases). Groups B and C comprised procedures after the learning phase involving attendings (n = 27, group B) or obstetrics and gynecology residents (n = 67, group C) as trainees. Groups were compared with respect to general outcome parameters and disease-free survival.
  
  
  RESULTS
  Patients within all groups were comparable with respect to age and height or body mass index. In the subgroup analysis, a decrease in blood loss and length of stay occurred mainly during the group B series. Pelvic lymph node yield reached oncologic standards during the initial learning curve (median 12-13) and remained stable during both teaching phases. Intraoperative and postoperative complications occurred in 2.4% and 13.7% of cases, respectively. Ninety percent of intraoperative and 64% of postoperative complications occurred within the first half of the series and were not correlated with type of assistance. Survival data were obtainable in 65% of cases with a median follow-up of 3.6 years. Disease free-survival was 92.5% in stage I disease and without significant difference among the groups.
  
  
  CONCLUSIONS
  After gaining proficiency in the procedure, more or less surgically experienced trainees can be actively included without hampering the progress of the attending's learning curve.
authors.affiliation: Department of Obstetrics and Gynecology, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA.
authors.forename: Markus C
authors.initials: MC
authors.lastname: Fleisch
authors.forename: J
authors.initials: J
authors.lastname: Newton
authors.forename: Ina
authors.initials: I
authors.lastname: Steinmetz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Whitehair
authors.forename: Alton
authors.initials: A
authors.lastname: Hallum
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Hatch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005858:Germany; D013509:Gynecologic Surgical Procedures / Q000193:education* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013663:Teaching; D016896:Treatment Outcome