Learning curves for laparoscopic hysterectomy after implementation of minimally invasive surgery

Objective: To evaluate the learning process for total laparoscopic hysterectomy (TLH) and laparoscopic supracervical hysterectomy (LSH) for benign uterine pathologies among surgeons inexperienced in laparoscopy. Methods: A retrospective comparative study was conducted of all hysterectomies performed by four attending surgeons and three resident surgeons at a tertiary university center in Homburg/Saar, Germany. Laparoscopic procedures were assessed between October 1, 2009, and October 31, 2010 (period A); November 1, 2010, and March 31, 2012 (period B); and April 1, 2012, and June 30, 2013 (period C). Data were obtained by medical chart review. Results: Overall, 269 patients underwent TLH and 165 underwent LSH. Duration of surgery for all surgeons decreased from 136 +/- 60 minutes in period A to 118 +/- 44 minutes in period B (P = 0.013), but increased to 122 +/- 56 minutes in period C (A vs C: P = 0.067). Among attending surgeons, the duration of surgery seemed to decrease after 20 TLH procedures and after 10 LSH procedures. Among resident surgeons, duration decreased after 10 LSH procedures; no fall was apparent for TLH. Conclusion: Both TLH and LSH were readily adopted among a group of surgeons inexperienced in laparoscopy, although LSH might be easier to learn. Experienced surgeons have a steeper learning curve than do their inexperienced counterparts. (C) 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.