Determining a Learning Curve for Contained Hand Tissue Extraction: Perioperative Outcomes and Operative Time

Abstract

Study ObjectiveTo compare the operative time of contained hand tissue extraction with power morcellation and to quantify the learning curve required to develop this skill. DesignA retrospective cohort study (Canadian Task Force classification II-3). SettingLahey Hospital and Medical Center, a suburban academic tertiary care center serving a broad base of patients. PatientsEighty-eight women undergoing laparoscopic hysterectomy requiring morcellation or tissue extraction from 2012 through 2015. InterventionsPower morcellation before the institution's ban on power morcellation and contained hand tissue extraction instituted in a response to the ban. Measurements and Main ResultsData were collected to compare the operative time and perioperative outcomes of morcellation before discontinuation of the power morcellator and after adaptation of a contained hand tissue extraction protocol. The data were then used to determine a learning curve for the new procedure. Eighty-eight consecutive cases of laparoscopic hysterectomy requiring morcellation were identified during the study duration, with 46 patients undergoing power morcellation and 42 undergoing hand tissue extraction. The 2 groups were similar overall in body mass index (28.9 vs 29.5, p = .70), prior laparoscopy (28% vs 21%, p = .46) or laparotomy (39% vs 21%, p = .07), removal of the cervix (56% vs 86%, p < .01), and uterine weight (581 vs 628 g, p = .56). The hand tissue extraction group had an average operating room time of 170 minutes compared with 154 minutes (p = .08) for the power morcellation group. The 2 surgeons performed 32 and 10 hand tissue extractions, respectively, with a decrease in 0.7 and 3 minutes per case, respectively, over the course of 7 months (p = .3 and .6, respectively). ConclusionContained hand tissue extraction was similar to power morcellation in the total operative time. The learning curve of surgeons performing contained hand tissue extraction showed a nonsignificant trend toward improvement in the operative time with an increasing number of cases.