Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital

Abstract

Study objective: To prospectively analyze the learning curve of laparoscopic-assisted vaginal hysterectomy (LAVH) in a surgical team and evaluate if length of surgery can be reduced safely.

Design: Prospective observational study (Canadian Task Force classification II-2).

Setting: Department of obstetrics and gynecology in a university-affiliated hospital.

Patients: One hundred and sixty consecutive women undergoing LAVH performed between January 1, 1998 and April 30, 2001.

Intervention: LAVH (AAGL Classification System for Laparoscopic Hysterectomy III-B-3).

Measurements and main results: The primary parameter evaluated was length of surgery. Patients were grouped in cohorts of 10, in order to perform a time curve that would assist us in evaluation of the learning process. Once the plateau was reached, we evaluated the process before and after this plateau (groups 1 [learning stage] and 2 [second stage], respectively). Average length of surgery was 126 minutes (range, 60-260). Length of surgery was 138 minutes (range, 75-260) in the learning stage (first 80 cases) and 112 minutes (range, 60-225) in the second stage (p <.0001). Total rate of complications was 11.6%. There were three major complications, and they occurred before the plateau. There were 15 minor complications (9.67%), 8 during the first stage and 7 in the second stage, (p =.9; NS). A second learning curve excluding LAVH with associated surgeries was obtained. The average length of surgery for the first stage was 133 minutes (range, 75-205) and 102 minutes for the second stage (range, 60-130) (p >.0001).

Conclusion: Analysis of the learning curve demonstrated that the length of surgery in LAVH could be reduced without increasing the number of complications.