Total Laparoscopic Hysterectomy – Analysis of Learning Points & Complications over a Span of Two Decades.

Abstract

Study Objective 1. Analysis of learning curve for Total laparoscopic hysterectomy (TLH); 2. Comparison of complication rates of 773 TLH between 1st & 2nd decade. Design Retrospective comparative analysis of prospectively collected data (Canadian Task force II – 2). Setting Centre for Endoscopic Surgery. Patients or Participants Total 773 patients posted for TLH over 20-years (2000-2019) for benign pathology excluding malignancy, anesthetic unfit and pelvic organ prolapse cases. Interventions Total Laparoscopic Hysterectomy with or without Bilateral Salpingo-oophorectomy. Measurements and Main Results All cases were divided into initial 10-years (group-I) of 386 cases and later 10-years (group-II) of 387 cases. No difference found in patient's demographic characteristic between first and second group. Analysis was done from prospectively collected data from outpatient and inpatient records elucidated in a structure pre-set protocol. Intra-operative variants were reviewed from real time video graphic records. Statistical method used, mean and standard deviation for operating time. P value for statistical significance. Chi-square test & Student t-test for continuous and categorical variables. Odd Ratio, univariate & multivariate logistic regression analysis for association. Significant reduction in mean operative-time was observed in first 125 to 250th case of TLH (p=0.001) which reflects the impact of learning. Comparison between group-I and group-II revealed significant reduction in major and minor complication rate from 3.35% to 1.03% (p=0.0277) and 1.81% to 0.25% (p = 0.033) respectively. The bladder complication in group-I and II were 8 & 2 respectively and only group-I had 4 ureteric and 1 bowel injury. Conversion rate was 7.3% throughout where endometriosis, 2 previous LSCS & bowel adhesions emerged as the strongest predictors of conversion with OR=6.72, 4.71 & 2.57 respectively. Conclusion Appropriate supervised training and increased experience after learning curve leads to marked reduction in operative time and complication rates of TLH. Conversion rate is independent of experience. 1. Analysis of learning curve for Total laparoscopic hysterectomy (TLH); 2. Comparison of complication rates of 773 TLH between 1st & 2nd decade. Retrospective comparative analysis of prospectively collected data (Canadian Task force II – 2). Centre for Endoscopic Surgery. Total 773 patients posted for TLH over 20-years (2000-2019) for benign pathology excluding malignancy, anesthetic unfit and pelvic organ prolapse cases. Total Laparoscopic Hysterectomy with or without Bilateral Salpingo-oophorectomy. All cases were divided into initial 10-years (group-I) of 386 cases and later 10-years (group-II) of 387 cases. No difference found in patient's demographic characteristic between first and second group. Analysis was done from prospectively collected data from outpatient and inpatient records elucidated in a structure pre-set protocol. Intra-operative variants were reviewed from real time video graphic records. Statistical method used, mean and standard deviation for operating time. P value for statistical significance. Chi-square test & Student t-test for continuous and categorical variables. Odd Ratio, univariate & multivariate logistic regression analysis for association. Significant reduction in mean operative-time was observed in first 125 to 250th case of TLH (p=0.001) which reflects the impact of learning. Comparison between group-I and group-II revealed significant reduction in major and minor complication rate from 3.35% to 1.03% (p=0.0277) and 1.81% to 0.25% (p = 0.033) respectively. The bladder complication in group-I and II were 8 & 2 respectively and only group-I had 4 ureteric and 1 bowel injury. Conversion rate was 7.3% throughout where endometriosis, 2 previous LSCS & bowel adhesions emerged as the strongest predictors of conversion with OR=6.72, 4.71 & 2.57 respectively. Appropriate supervised training and increased experience after learning curve leads to marked reduction in operative time and complication rates of TLH. Conversion rate is independent of experience.