Evaluation of the Learning curve in Total laparoscopic hysterectomy

Abstract

Introduction: Laparoscopic hysterectomy is a minimally invasive surgery. Retrospective studies have demonstrated a number of advantages of laparoscopic hysterectomy. There is a lot of concern over the training period of it, as it is associated with higher complications during training period. Many studies suggest that complication rates are inversely proportional to the volume of surgical work load. Objective : To assess the learning curve in Total laparoscopic hysterectomy. Material and method : This study had included consecutive 140 cases of total laparoscopic hysterectomy for benign gynecological conditions were considered performed during the period May 2010 to April 2013. We had made first 70 cases as early group and later 70 cases as late group. Results: The mean operating time in early group was 101min and in late group was 81min (P= 0.000). There were total of five complications, three in early group and two in late group. Mean Hb deficit in early was 1.83% as compared to 1.14% in late case which was statistically significant (0.00). Mean hospital stay was 3.31 day as compared to 2.14 day in late group. Discussion: Reduction in operating time and perioperative complications are the two factors most often quoted in the medical literature. Our analysis showed statistically significant reduction in operating time, hemoglobin drop and hospital stay in late group as compared to early group. But the complication rates were not statistically significant. There was a positive association between the size of uterus and operating in both the group and overall as shown by correlation coefficient. Conclusion: There need to be minimum number of 70 surgeries needs to be performed to improve the outcome significantly. Total laparoscopic surgeries can be performed safely during the learning curve.