title: Fellowship learning curve associated with completing a robotic assisted total laparoscopic hysterectomy.
abstract: OBJECTIVE
  To describe the learning curve associated with training fellows in completing robotic assisted total laparoscopic hysterectomies.
  
  
  METHODS
  All patients scheduled to undergo a robotic procedure at our institution from 5/15/07 to 5/22/12 were identified. Fellow participation per procedure was documented. The learning curve of fellows for the time to complete a hysterectomy (from initiation of developing the retroperitoneal space to the completion of the colpotomy) was analyzed.
  
  
  RESULTS
  Of the 1754 planned robotic cases, 1626 were completed robotically and 128 were converted to laparotomy. Fifty-seven fellows participated in 99.7% of the cases. Eleven gynecologic oncology fellows completed at least 1 robotic assisted total laparoscopic hysterectomy. From 7/7/08 to 5/21/12, 981 hysterectomies were completed robotically, 254 of these (25.9%) by the 11 fellows. Prior to completing a hysterectomy, the median number of hysterectomies in which a fellow participated was 16 (range, 11-40). Median amount of time for a fellow to complete a hysterectomy decreased from 60 min in 2009 (N=27 cases) to 31 min in 2011 (N=148 cases). Based on the recorded completion times in which the 11 fellows completed a hysterectomy, it required ~33 cases per fellow to be able to perform the hysterectomy and overcome the learning curve.
  
  
  CONCLUSIONS
  The learning curve associated with hysterectomy requires completion of ~33 cases by the fellow after an initial median experience of 16 cases. Our data suggest that a minimum of 50 total cases is required during fellowship to complete a robotic hysterectomy.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Samith
authors.initials: S
authors.lastname: Sandadi
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Gadzinski
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Jewell
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Brown
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. Electronic address: gynbreast@mskcc.org.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005257:Fellowships and Scholarships; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000193:education*; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008875:Middle Aged; D012371:Robotics / Q000193:education*
keywords: Minimally invasive surgery; Robotic assisted laparoscopic hysterectomy; Total laparoscopic hysterectomy