Learning Curve for Single-Port-Access Laparoscopic Surgery in Benign Adnexal Mass

Abstract

Study Objective: To evaluate and quantify the learning curve for single-port-access (SPA) laparoscopic surgery in benign adnexal mass.Design: Retrospective analysis of 42 cases of SPA laparoscopic surgery for benign adnexal mass.Setting: Tertiary referral, teaching hospital.Patients: Forty-two patients (ages 17-69 yrs) indicated to laparoscopic surgery due to benign adnexal mass.Intervention: SPA laparoscopic surgery by the operators already skilled in conventional laparoscopic procedures.Measurements and Main Results: Adnexal tumors were measured by average 5.8 (1-20) cm, and composed of three main disorders including endometriotic cyst (n=13; 31%), benign epithelial cyst (n=11; 26.2%), and mature cystic teratoma (n=10; 23.8%). SPA laparoscopic surgery was successful in most cases (n=36; 85.7%). However, 4 (9.5%) cases needed one more trocar due to severe pelvic adhesions, and another 2 (4.8%) cases were finally converted to conventional laparoscopic surgery. Average operation time and estimated blood loss (EBL) during surgery were measured 87.6 (14-155) min and 122.0 (50-300) ml, respectively. EBL were significantly decreased from 148.3 to 102.1 ml (p=0.025), when the cut-off value of learning curve was defined 6 cases per one laparoscopic surgeon (initial group; n=18 vs. late group; n=24). Operation time was also shortened, although not significant (90 vs. 85 min). Other clinico-surgical parameters such as age, parity, history of previous operations, mass size, indications of surgery, grades of pelvic adhesion, pre- & post- Hb level and postoperative complications were not different between two groups except BMI (20.5 vs. 22.7 kg/m2; p=0.035). Postoperative complication rates were nearly absent; only one case of wound dehiscence.Conclusion: SPA surgery may be feasible and safe in benign adnexal disease, and easily learned by laparoscopic surgeons who already experienced conventional laparoscopic procedures. Study Objective: To evaluate and quantify the learning curve for single-port-access (SPA) laparoscopic surgery in benign adnexal mass. Design: Retrospective analysis of 42 cases of SPA laparoscopic surgery for benign adnexal mass. Setting: Tertiary referral, teaching hospital. Patients: Forty-two patients (ages 17-69 yrs) indicated to laparoscopic surgery due to benign adnexal mass. Intervention: SPA laparoscopic surgery by the operators already skilled in conventional laparoscopic procedures. Measurements and Main Results: Adnexal tumors were measured by average 5.8 (1-20) cm, and composed of three main disorders including endometriotic cyst (n=13; 31%), benign epithelial cyst (n=11; 26.2%), and mature cystic teratoma (n=10; 23.8%). SPA laparoscopic surgery was successful in most cases (n=36; 85.7%). However, 4 (9.5%) cases needed one more trocar due to severe pelvic adhesions, and another 2 (4.8%) cases were finally converted to conventional laparoscopic surgery. Average operation time and estimated blood loss (EBL) during surgery were measured 87.6 (14-155) min and 122.0 (50-300) ml, respectively. EBL were significantly decreased from 148.3 to 102.1 ml (p=0.025), when the cut-off value of learning curve was defined 6 cases per one laparoscopic surgeon (initial group; n=18 vs. late group; n=24). Operation time was also shortened, although not significant (90 vs. 85 min). Other clinico-surgical parameters such as age, parity, history of previous operations, mass size, indications of surgery, grades of pelvic adhesion, pre- & post- Hb level and postoperative complications were not different between two groups except BMI (20.5 vs. 22.7 kg/m2; p=0.035). Postoperative complication rates were nearly absent; only one case of wound dehiscence. Conclusion: SPA surgery may be feasible and safe in benign adnexal disease, and easily learned by laparoscopic surgeons who already experienced conventional laparoscopic procedures.