Journal of Minimally Invasive Gynecology
Journal of Minimally Invasive Gynecology
5 years ago

The Power Law of Learning in Transumbilical Single-Port Laparoscopic Subtotal Hysterectomy

To analyze the surgical outcomes and learning curve of transumbilical single-port laparoscopic subtotal hysterectomy which requires sutures of the cervical stump. Design Prospective observational study (Canadian Task Force Classification II-2). Setting University-affiliated center. Patients From the first (July 2012) and consecutive patients of benign uterine disease scheduled for subtotal hysterectomy till October 2013. Interventions All single-port laparoscopies were performed using straight instruments by one gynecologist. An ancillary port was added whenever technical difficulties could endanger surgical quality. Measurement and Main Results 75 patients were recruited for intention-to-treat analysis with a mean (±SD) age of 44.7±3.8 years and a body mass index of 24.2±3.7 kg/m2. No major complication was noted. The mean uterine weight was 432.5±344.0g with 24 (32%) of which ≧500gm. The patient's sequential order, or gradually increasing experience, was the determining factor in progressively decreasing operative time. Further, most cases that required additional ancillary port (67%) were clustered in the first 20 cases, while four were scattered after the 47th patient because of severe pelvic adhesion. The mean operative time decreased in the power-law function of the patient's sequential order with a plateau achieved at the 20th patient. Conclusions The patient's sequential order was identified as an independent factor of achieving purely single-port access and the trend of decreasing operative time delineated the existence of a learning curve. Approximate 20 patients were needed for an experienced multi-port laparoscopist to reach technical competency in the current series.

Publisher URL: www.sciencedirect.com/science

DOI: S1553465018300542

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