Retrospective study evaluating the early impact of a formal laparoscopic training program on the management of dermoid cysts

Abstract

Objective: To evaluate outcomes of laparoscopic management of dermoid cysts after the institution of a formal laparoscopic training program at the University of Miami. Design: This is a retrospective comparative analysis of patients that had laparoscopic surgery at the University of Miami/Jackson Memorial Hospital from January 1998 to August 2001 for benign cystic teratomas. Materials and Methods: This is a retrospective study of 53 patients who had laparoscopic management of dermoid tumors at the University of Miami/Jackson Memorial Hospital from January 1998 to August 2001. In October 1999 an ongoing formal laparoscopic training program was instituted involving didactics, bench skills training, animate model surgery, and supervised surgery. Patients with a pre-operative diagnosis for suspected dermoid cyst were included in the study. Outcome variables measured included size of dermoid, spillage rates, estimated blood loss, operative time, hospital stay, complications, cost, resident training level and participation in formal training. Statitistical comparisons were made by Student’s t-tests, Chi square analysis, or Fisher’s exact tests. Statistical significance was defined as P-value <0.05. Results: Of the 250 patients who underwent surgical management of dermoid cyst, 197 (78.8%) were excluded because of concomitant major gynecologic surgery or laparotomy and the remaining 53 (21.2%) underwent dermoid management via laparoscopy. Of the 53 cases, 17 (32%) occurred prior to training and 36 (68%) after the institution of the formal training program. The size of dermoid cyst, spillage rates, estimated blood loss, operative time, hospital stay, complications, and hospital costs did not differ among both groups in this early analysis. Of the 9 patients that were converted to laparotomy due to size of the mass or dense adhesions, 8 (89%) were performed prior to the implementation of the training program (p<0.01). The resident training level and participation in formal training was equally distributed with third and fourth year residents performing most cases. The management of dermoids by laparoscopy was increased from 36% to 59% in the “formal training group” (p<0.05). Conclusions: A formal training program in laparoscopy impacts the conversion to laparotomy and the decision-making regarding surgical route of dermoid management.