title: In Laparoscopic Myomectomy, Does a Caseload of 100 Patients During the Learning Curve Produce a Significant Improvement in Performance Measures?
abstract: OBJECTIVE
  Laparoscopic myomectomy (LM) offers considerable advantages over open myomectomy; however, LM is technically complex and associated with a steep learning curve. Few studies have evaluated the effect of the learning curve, and the limitations of most of these studies were the number of women included and the multiplicity of surgeons undertaking the procedure. The aim of this study is to evaluate the effect of a caseload of 100 patients during the learning curve of a single experienced surgeon performing LM.
  
  
  METHODS
  A prospective comparative analysis of 200 consecutive cases of LM was conducted between December 2004 and March 2013. Outcomes of the first 100 procedures (Group A) were compared with the later 100 (Group B).
  
  
  RESULTS
  The mean age of the cohort was 39 years (24-54 years), with a mean BMI of 27 kg/m(2) (16-46). Both the groups were very similar with regard to the number, size and weight of myomas removed, the duration of surgery, and blood loss. More women were sent home within 24 h in the second group (27 vs 10.2 %, p = 0.002). Group A suffered significantly higher complication rates compared to Group B (11 vs 7, p < 0.05). The laparotomy conversion rate was 1.5 % (3 in Group A, none in Group B).
  
  
  CONCLUSIONS
  After a caseload of 100 patients during the learning curve, there was no difference in outcomes apart from increased confidence to discharge patients after 24 h and reduced complication rates. Thus, mere numbers do not influence the number/size of fibroids removed, operating time, or blood loss but do influence complication rates and post-operative discharge times.
authors.affiliation: Faculty of medicine, Imperial College London, Imperial College Road, London, SW7 2AZ UK.
authors.forename: Savan
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Obstetrician and Gynaecologist, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, E11 1NR UK.
authors.forename: Jimi F
authors.initials: JF
authors.lastname: Odejinmi
authors.affiliation: Department of Obstetrician and Gynaecologist, North West London Hospital NHS Trust, Northwick Park Hospital, Watford Road, London, HA1 3UJ UK.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Agarwal
keywords: Fibroid; Laparoscopy; Leiomyoma; Myoma; Myomectomy