title: Impact of laparoscopic sacrocolpopexy learning curve on operative time, perioperative complications and short term results.
abstract: OBJECTIVE
  Laparoscopic sacrocolpopexy (LSCP) learning is a challenge for unexperienced surgeons, since complications occurrence and anatomical results could depend from surgeon's experience. The aim of this study was to describe LSCP characteristics, perioperative complications and short term anatomical results when LSCP was performed by LSCP-experienced surgeons or trainees.
  
  
  METHODS
  Patients who underwent LSCP in our surgical unit in the last ten years were included. Patients were excluded if laparotomy was performed without any laparoscopic time. Interventions were divided into LSCP experienced surgeons (who had performed at least 30 procedures) and trainees (residents, fellows, and surgeons with less than 30 procedures). Main outcomes were operative time, peroperative complications (included conversions to open or vaginal surgery, bladder and vaginal perforation, epigastric vessels injury and hemorrhage) early postoperative complications, mesh complications and anatomical results at three months.
  
  
  RESULTS
  492 patients were included, 108 in the trainee group and 384 in the LSCP-experienced group. Groups were comparable for demographics, preoperative clinical examination and surgery characteristics. Average operative time was significantly higher in trainees group than in LSCP-experienced group (251 versus 178 min (p<0.0001)). There was no difference in open surgery conversion rate (5.6% versus 3.9%, p=0.42) or peroperative complication occurrence (4.7% versus 4.6%, p=0.98). Bladder perforations were more frequent in trainee group but difference was not statistically significant (3.7% versus 1.3%, p=0.11). 98% patients were assessed at three months. Overall anatomical success rate was 94.9%. There was no difference in anatomical failure rate between trainee group and LSCP experienced surgeons group (respectively 4.7% versus 5.2%, p=0.82), neither in mesh complication rate (3.9% versus 2.8%, p=0.77).
  
  
  CONCLUSIONS
  LSCP learning in an experimented surgical team induces high operative time, but remains safe for patient.
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France. Electronic address: vdddv@live.fr.
authors.forename: David
authors.initials: D
authors.lastname: Vandendriessche
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Giraudet
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lucot
authors.affiliation: Methodology and Biostatistics Unit, EA2694, UDSL2, University Lille Nord de France, University Hospital of Lille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Behal
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Cosson
mesh_terms: D015331:Cohort Studies; D003127:Colposcopy / Q000009:adverse effects* / Q000193:education; D005260:Female; D005500:Follow-Up Studies; D005602:France; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000193:education; D006801:Humans; D007318:Inservice Training; D007431:Intraoperative Complications / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects* / Q000193:education; D059032:Learning Curve; D061646:Operative Time; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control*; D011361:Professional Competence; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D013526:Surgical Mesh / Q000009:adverse effects
keywords: Complications; Laparoscopic sacrocolpofixation; Learning curve