Assessing the Learning Curve for Laparoscopic Supracervical Hysterectomy

OBJECTIVE: We assessed the learning curve for laparoscopic supracervical hysterectomy. METHODS: This was a prospective cohort study. We analyzed the first 60 consecutive laparoscopic supracervical hysterectomy procedures performed by a team of 2 gynecological laparoscopic surgeons between May 2001 and July 2006 to examine whether a learning curve exists as defined by a decrease in operating time and complications as the sequence increased. Based on previous reports, we defined the first 30 laparoscopic supracervical hysterectomies as “early” cases and the subsequent cases as “late” cases. RESULTS: The mean operating time for laparoscopic supracervical hysterectomy was significantly reduced from 166 minutes to 142.3 minutes (P≤0.05) between the early and the late cases. The mean first postoperative day drop in hemoglobin between the early and the late cases was from 2.4gm/dL to 2.0gm/dL (P=0.08). Two complications occurred in the series: one delayed bowel injury in the early cases and one conversion to laparotomy due to a cystotomy in the late cases. No difference existed between the early and the late patients regarding age, parity, body mass index, uterine weight, previous abdominal surgery, or hospital stay. There was an overall linear correlation between the operating time and uterine weight (R=0.384). CONCLUSION: There is a learning curve for laparoscopic supracervical hysterectomy. After gaining experience in performing 30 cases, the operating time is significantly reduced. The operation can be performed safely during the learning period.