A single center surgical experience in total laparoscopic hysterectomy and the effect of variables on operation time: Do the uterine volume and the suture type influence the operation time?

OBJECTIVES: Online education and certification programs which help most gynecologic surgeons to advance, improve and prove their skills. However, the benefits of such distant programs in terms of complication rate and operation time has not been evaluated so far. The aim of this study was to report the improvement of a single surgeon’s learning curve in total laparoscopic hysterectomy who had no previous mentorship/fellowship education, working in a rural district hospital before and after the completion of a distant on-line education and certification program - Gynaecological Endoscopic Surgical Education and Assessment. STUDY DESIGN: Medical records of patients who underwent total laparoscopic hysterectomy between May 2015 and December 2018 were retrospectively reviewed and grouped based on the certification date of the surgeon, Group 1 before and Group 2 after certification. Groups were compared for variables that impact the learning curve (operation time, complications and conversion to laparotomy) RESULTS: Of the 57 women eligible for evaluation 30 had total laparoscopic hysterectomy in Group 1 and 27 had total laparoscopic hysterectomy in Group 2. BMI, number of vaginal/cesarean births, previous abdominal/pelvic surgeries, operation indications, uterine weight, adnexectomy, and adhesiolysis rates, transfusion requirements, and the decrease in hemoglobin before and after operation were similar between the groups (p>0.05). Operation time was significantly shorter in Group 2 (83 min vs.116 min, p<0.0001). CONCLUSION: Thirty total laparoscopic hysterectomy operations seem enough to reach a plateau in the learning curve for gynecologists working in rural areas with limited facilities who cannot afford lengthily and expensive fellowship/mentorship programs, after completing distant online certification programs.

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Total Laparoscopic Hysterectomy in Patients with Large Uteri: Comparison of Uterine Removal by Transvaginal and Uterine Morcellation Approaches

BioMed Research International ◽

10.1155/2016/8784601 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Haibo Wang ◽

Ping Li ◽

Xiujuan Li ◽

Licai Gao ◽

Caihong Lu ◽

...

Keyword(s):

Intraoperative Complications ◽

Length Of Hospital Stay ◽

Operation Time ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Postoperative Outcomes ◽

Statistical Significant Difference ◽

Removal Time ◽

Significant Difference ◽

Large Uterus

The aim of this study was to compare the clinical results of total laparoscopic hysterectomy (TLH) for large uterus with uterus size of 12 gestational weeks (g.w.) or greater through transvaginal or uterine morcellation approaches. We retrospectively collected the clinical data of those undergoing total laparoscopic hysterectomies between January 2004 and June 2012. Intraoperative and postoperative outcomes were compared between patients whose large uterus was removed through transvaginal or morcellation approaches. The morcellation group has significantly shorter mean operation time and uterus removal time and smaller incidence of intraoperative complications than the transvaginal group (allP<0.05). No statistical significant difference regarding the mean blood loss, uterine weight, and length of hospital stay was noted in the morcellation and transvaginal groups (allP>0.05). In two groups, there was one patient in each group who underwent conversion to laparotomy due to huge uterus size. With regard to postoperative complications, there was no statistical significant difference regarding the frequencies of pelvic hematoma, vaginal stump infection, and lower limb venous thrombosis in two groups (allP>0.05). TLH through uterine morcellation can reduce the operation time, uterus removal time, and the intraoperative complications and provide comparable postoperative outcomes compared to that through the transvaginal approaches.

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Comparing Surgical Experience and Skill Using a High-Fidelity, Total Laparoscopic Hysterectomy Model

Obstetrics and Gynecology ◽

10.1097/aog.0000000000003897 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Chetna Arora ◽

Anya Menzies ◽

Esther S. Han ◽

Minyi Lee ◽

Jacob K. Lauer ◽

...

Keyword(s):

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

High Fidelity ◽

Surgical Experience

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The Impact of Systematic Laparoscopic Skills and Suture Training on Laparoscopic Hysterectomy Outcomes in a Brazilian Teaching Hospital

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0039-1700587 ◽

2019 ◽

Vol 41 (12) ◽

pp. 718-725

Author(s):

Anna Luiza Lobão Gonçalves ◽

Helizabet Abdala Ayroza-Ribeiro ◽

Raquel Ferreira Lima ◽

Aline Estefane Eras Yonamine ◽

Fabio Ohara ◽

...

Keyword(s):

Hospital Stay ◽

Teaching Hospital ◽

Operative Time ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Surgical Time ◽

Laparoscopic Skills ◽

Group I ◽

The Impact ◽

Uterine Volume

Abstract Objective To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital. Methods A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) – TLHs performed by senior attending physicians; 2010-11 (I-2) – TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) – TLHs performed by residents after the implementation of the SLSST program. Results A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p = 0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p = 0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p = 0.030), logistic regression did not find any association between uterine volume and surgical time (p = 0.103). Conclusion The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.

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