2018, Number 01
Ginecol Obstet Mex 2018; 86 (01)
Learning curve of laparoscopic hysterectomy. How many interventions are required to consider the technique dominated with safety standards?
Pantoja-Garrido M, Frías-Sánchez Z, Vilar-Sánchez Á, León-del Pino R, Vico-de Miguel FJ, Pantoja-Rosso FJ
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ABSTRACTObjective: To observe the learning curve in a surgical team of laparoscopic hysterectomy. Determine the number of surgeries needed to achieve a surgical time 90 minutes average, a percentage of total complications less than 10% and a conversion to laparotomy rate to less than 5%.
Material and Methods: For this we have analyzed data collected prospectively, in 45 patients undergoing total laparoscopic hysterectomy or laparoscopic supracervical hysterectomy, carried out by the same surgical team, and divided into 3 cohorts of 15 patients by temporal order of preparation; made July 2014 to October 2017, in the Department of Gynecology of the Hospital General Santa Maria del Puerto.
Results: We analized 45 procedures divided into 3 cohorts of 15 patients each according to the temporal order of performance. Thus, group 1 was that of the first 15 hysterectomies performed, group 2 from 16 to 30, and group 3 from 31 to 45; that is, the last 15 carried out. The conversion rate to laparotomy in group 1 was 13.3%, and in 2 and 3 of 0% (p = 0.123). The mean surgical time in group 1 was 164 minutes, in 2 of 101 minutes and in 3 of 90 minutes (p = 0.001). Among the different groups there were statistically significant progressive improvements in the loss of hemoglobin or hospital stay.
Conclusions: Our results indicate that a learning curve of 45 interventions is sufficient to deal with this type of surgery with safety standards.