OBJECTIVE: The aim of this study was to evaluate the factors considered for pr oficiency and to estimate the number of procedures needed to achieve competence in laparoscopic-assisted vaginal hysterectomy in a teachin...OBJECTIVE: The aim of this study was to evaluate the factors considered for pr oficiency and to estimate the number of procedures needed to achieve competence in laparoscopic-assisted vaginal hysterectomy in a teaching hospital. METHODS: The length of the learning curve, duration of surgery, change of hemoglobin (in grams per liter), conversion rate, and intra-and postoperative complications we re evaluated. Cases were analyzed according to the order for the individual surg eon. RESULTS: Thirty-three surgeons performed 929 laparoscopic-assisted vagina l hysterectomies during the study period. Analyzing the duration of surgery and rate of complications, we decided on a cutoff of 30 cases. Eight surgeons with m ore than 30 cases performed 668 laparoscopic-assisted vaginal hysterectomies. T heir initial 30 cases (group A, the first 30 cases) were compared with their subsequent cases (group B, cases 31 and after). Patient age, body mass index, and uterine weight did not differ b etween the groups. The intraoperative complication rate dropped from 4.2%to 0.5 %(P = .001), hemoglobin drop decreased from -0.8 ±0.9 g/L to -0.5 ±.1.0 g/L (P = .002), and postoperative complications dropped from 12.9%to 7.0%(P = .01 7). The duration of surgery was also shorter (148.8 ±45.4 minutes versus 125.1 ±46.5 minutes), but this difference was taken from the results of 1 surgeon. CO NCLUSION: A learning experience of 30 laparoscopic-assisted vaginal hysterectom ies was necessary in our institution to reach a low level of complications. Dura tion of the surgical procedure was not an adequate study endpoint to assess a le arning effect.展开更多
文摘OBJECTIVE: The aim of this study was to evaluate the factors considered for pr oficiency and to estimate the number of procedures needed to achieve competence in laparoscopic-assisted vaginal hysterectomy in a teaching hospital. METHODS: The length of the learning curve, duration of surgery, change of hemoglobin (in grams per liter), conversion rate, and intra-and postoperative complications we re evaluated. Cases were analyzed according to the order for the individual surg eon. RESULTS: Thirty-three surgeons performed 929 laparoscopic-assisted vagina l hysterectomies during the study period. Analyzing the duration of surgery and rate of complications, we decided on a cutoff of 30 cases. Eight surgeons with m ore than 30 cases performed 668 laparoscopic-assisted vaginal hysterectomies. T heir initial 30 cases (group A, the first 30 cases) were compared with their subsequent cases (group B, cases 31 and after). Patient age, body mass index, and uterine weight did not differ b etween the groups. The intraoperative complication rate dropped from 4.2%to 0.5 %(P = .001), hemoglobin drop decreased from -0.8 ±0.9 g/L to -0.5 ±.1.0 g/L (P = .002), and postoperative complications dropped from 12.9%to 7.0%(P = .01 7). The duration of surgery was also shorter (148.8 ±45.4 minutes versus 125.1 ±46.5 minutes), but this difference was taken from the results of 1 surgeon. CO NCLUSION: A learning experience of 30 laparoscopic-assisted vaginal hysterectom ies was necessary in our institution to reach a low level of complications. Dura tion of the surgical procedure was not an adequate study endpoint to assess a le arning effect.
