Vol 93, No 9 (2022)
Research paper
Published online: 2022-04-06

open access

Page views 4077
Article views/downloads 507
Get Citation

Connect on Social Media

Connect on Social Media

The effect of experience on the outcomes of total laparoscopic hysterectomy surgery: 1295 cases

Meric Balikoglu12, Burak Bayraktar1, Dilber Filiz1, Emrah Beyan1, Abdurrahman Hamdi Inan1, Mehmet Ozeren1
Pubmed: 35419792
Ginekol Pol 2022;93(9):681-685.

Abstract

Objectives: To reveal the effect of surgeon's experience on the outcomes of the total laparoscopic hysterectomy (TLH) surgery. Material and methods: Design: Retrospective case series. Setting: A tertiary care university hospital. Patients: 1295 cases with an indication for hysterectomy. Interventions: Total laparoscopic hysterectomy. Results: All cases were grouped according to the surgeon’s experience. For 30 different surgeons, their first 20 operations constituted Group A, 21st–50th operations Group B, 51st–100th operations Group C, and their operations after the 100th surgery Group D. Demographic data and post-operative results were compared between the groups. There were no statistical differences in terms of demographic data and major complications. A statistically significant decrease was observed in the post-operative fall in hemoglobin level and the duration of hospitalization in the groups with increased experience (p = 0.021, p < 0.001, respectively). There wasn’t an increase in uterine specimen weight with increased experience (p = 0.267). Conclusions: We obtained that the peak value in the learning curve cannot be evaluated according to the operation time or complication rates. Although the complication rate seems unaffected by surgical experience, concerns about complications may decrease as experience increases. Since the trend of minimally invasive surgery will continue increasingly in the next century because of higher patient comfort, all gynecologists should gain competence in endoscopic surgery.

Article available in PDF format

View PDF Download PDF file

References

  1. Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol. 2007; 19(4): 337–344.
  2. Garry R, Fountain J, Brown J, et al. EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess. 2004; 8(26): 1–154.
  3. Lee SH, Oh SoRa, Cho YJ, et al. Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis. BMC Womens Health. 2019; 19(1): 83.
  4. Kala E, Stojko R, Sadlocha M. Hysterectomy costs depending on operational technique. Ginekol Pol. 2018; 89(12): 672–676.
  5. Settnes A, Moeller C, Topsoee MF, et al. Complications after benign hysterectomy, according to procedure: a population‐based prospective cohort study from the Danish hysterectomy database, 2004–2015. BJOG: An International Journal of Obstetrics & Gynaecology. 2020; 127(10): 1269–1279.
  6. Orhan A, Ozerkan K, Kasapoglu I, et al. Laparoscopic hysterectomy trends in challenging cases (1995-2018). J Gynecol Obstet Hum Reprod. 2019; 48(10): 791–798.
  7. Barron KI, Richard T, Robinson PS, et al. Association of the U.S. Food and Drug Administration morcellation warning with rates of minimally invasive hysterectomy and myomectomy. Obstet Gynecol. 2015; 126(6): 1174–1180.
  8. Mavrova R, Radosa JC, Wagenpfeil G, et al. Learning curves for laparoscopic hysterectomy after implementation of minimally invasive surgery. Int J Gynaecol Obstet. 2016; 134(2): 225–230.
  9. Terzi H, Biler A, Demirtas O, et al. Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg. 2016; 35: 51–57.
  10. Brummer THI, Seppälä TT, Härkki PSM. National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000-2005. Hum Reprod. 2008; 23(4): 840–845.
  11. Hoffman CP, Kennedy J, Borschel L, et al. Laparoscopic hysterectomy: the Kaiser Permanente San Diego experience. J Minim Invasive Gynecol. 2005; 12(1): 16–24.
  12. Heinberg EM, Crawford BL, Weitzen SH, et al. Total laparoscopic hysterectomy in obese versus nonobese patients. Obstet Gynecol. 2004; 103(4): 674–680.
  13. Walsh CA, Walsh SR, Tang TY, et al. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2009; 144(1): 3–7.
  14. Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol. 2002; 99(2): 229–234.
  15. Cianci S, Gueli Alletti S, Rumolo V, et al. Total laparoscopic hysterectomy for enlarged uteri: factors associated with the rate of conversion to open surgery. J Obstet Gynaecol. 2019; 39(6): 805–810.
  16. Vakili B, Chesson RR, Kyle BL, et al. The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy. Am J Obstet Gynecol. 2005; 192(5): 1599–1604.
  17. Ribeiro S, Reich H, Rosenberg J, et al. The value of intra-operative cystoscopy at the time of laparoscopic hysterectomy. Hum Reprod. 1999; 14(7): 1727–1729.
  18. Visco AG, Taber KH, Weidner AC, et al. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol. 2001; 97(5 Pt 1): 685–692.
  19. Yuksel S, Serbetcioglu GC, Alemdaroglu S, et al. An analysis of 635 consequetive laparoscopic hysterectomy patients in a tertiary referral hospital. J Gynecol Obstet Hum Reprod. 2020; 49(1): 101645.
  20. Obermair A, Manolitsas TP, Leung Y, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer. International Journal of Gynecologic Cancer. 2005; 15(2): 319–324.