title: Does the learning curve of conservative laparoscopic surgery in women with rectovaginal endometriosis impair the recurrence rate?
abstract: OBJECTIVE
  To assess the effect of surgeon's increasing experience in conservative laparoscopic surgery of women with rectovaginal endometriosis on the surgical outcome of these patients recurrence rate.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  The first 60 consecutive patients undergoing laparoscopic conservative surgery for symptomatic rectovaginal endometriosis at our institution during a 4- year period.
  
  
  METHODS
  Cases were classified into two groups according to the date of the patient's operation: the first 30 cases were defined as the early cases and the subsequent 30 cases as the late cases.
  
  
  METHODS
  Operating time, perioperative complications, and surgical outcome. Univariate and multivariate analyses for risk factors with recurrence of disease.
  
  
  RESULTS
  The two groups were similar in patient characteristics. There was a reduction in the rate of laparoconversion, operating time, estimated amount of blood loss, cases with incomplete removal, and recurrence rate with increasing surgeon's experience. Surgical completeness was significantly associated with recurrence of disease.
  
  
  CONCLUSIONS
  A learning curve is demonstrated in the conservative laparoscopic management of patients with rectovaginal endometriosis. After gaining experience in performing 30 cases, the recurrence rate is significantly reduced.
authors.affiliation: Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: f.carmona@ub.edu.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carmona
authors.affiliation: Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Martínez-Zamora
authors.affiliation: Institut Clínic of Digestive Diseases, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: González
authors.affiliation: Institut Clínic of Digestive Diseases, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Ginés
authors.affiliation: Imaging Diagnosis Center, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Buñesch
authors.affiliation: Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Balasch
mesh_terms: D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D004715:Endometriosis / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery