title: Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands.
abstract: OBJECTIVE
  To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands.
  
  
  METHODS
  Prospective multicenter study (Canadian Task Force II-2).
  
  
  METHODS
  Ten community (teaching) hospitals in the Netherlands.
  
  
  METHODS
  A total of 631 women who underwent permanent sterilization by tubal microinserts.
  
  
  METHODS
  Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement.
  
  
  METHODS
  Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications.
  
  
  RESULTS
  Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience.
  
  
  CONCLUSIONS
  A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience.
authors.affiliation: Department of Gynecology and Obstetrics, St. Antonius Hospital, Nieuwegein, the Netherlands. julienne.janse@gmail.com
authors.forename: Juliënne A
authors.initials: JA
authors.lastname: Janse
authors.forename: Thyrza O S
authors.initials: TO
authors.lastname: Pattij
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Broekmans
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Veersema
authors.forename: Henk W R
authors.initials: HW
authors.lastname: Schreuder
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D015907:Hysteroscopy / Q000193:education*; D007434:Intrauterine Devices / Q000009:adverse effects; D059032:Learning Curve; D008875:Middle Aged; D009426:Netherlands; D010147:Pain Measurement; D010149:Postoperative Pain; D010820:Physicians / Q000523:psychology*; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000193:education*; D000078329:Workforce
keywords: Essure; experience; hysteroscopy; learning curve; sterilization