Learning curve of minimally invasive two-port laparoscopic myomectomy

Abstract

BACKGROUND AND OBJECTS: To examine the learning curve of minimally invasive 2-port total laparoscopic myomectomy (TTLM).

Methods: TTLM was performed by using only umbilicus and left inguinal ports, for 30 patients at our university affiliated hospital between May 2009 and February 2010. The times required for each of the 5 surgical phases of the early and late cases performed by the same surgeon were compared by using a DVD time counter.

Results: The mean surgical time was 82.5±5.2 minutes, blood loss was 42.1±7.5mL, and weight of specimen was 65.3±13.3g. The eighth case was the first in which the surgical time fell below the overall mean surgical time. Comparison of the mean time of each phase between the 7 early and the subsequent (late) cases revealed significant differences in the times required for suturing.

Conclusions: Although this was a feasibility study, the results suggest that this technique can be mastered after 7 cases. Learning curve, Suturing.

Figure 1.

Trocar ports were positioned as shown in this figure. The 12-mm and 5-mm umbilical trocar ports were positioned so that they would be vertically aligned.

Figure 2.

This figure describes the procedure of TLM using the 2-port technique. The photos shown were taken at the time of setting the trocars, incising the myometrium, performing an enucleation, continuous interlock suture, making an Aberdeen knot, collecting of resected specimen with electric morcellator, and finishing the surgery.

Figure 3.

(3–1) The graph shows the duration of surgeries. The cases with the asterisks greatly exceeded the average operation time. They were the cases of degeneration myomas (3–2). The graph shows the duration of operations with the 2 cases removed that greatly exceeded the average in Figure 3–1. The square shows the average +2SD. A black arrow shows the seventh case falling below the average +2SD, which is the first case to do so. Therefore, the seventh operation and those after it, including the operation itself, were regarded as late cases and those before this operation as early cases.

Figure 4.

These graphs show each phase of the operation. Only at the suturing phase was a significant difference noted in the comparison between the early and late cases (P=0.021; Mann-Whitney U test).