Learning curve for hysterectomy in a high-volume-hospital after implementation of endoscopic procedure

Introduction: The role of endoscopic surgery is rising in the gynecology. The aim of the present study was to characterize the learning curve for laparoscopic hysterectomy including total hysterectomy (TLH) and supracervical hysterectomy (LASH) and to identify factors that influence this learning curve. An interesting fact is that the operating technique for hysterectomy was completely changed from non-laparoscopic to laparoscopic procedure overnight in October 2009.

Materials and methods: We retrospectively analyze the medical records of 435 women who underwent either TLH or LASH at our high-volume hospital during 10/2009 and 06/2013. We compare patient characteristics, intraoperative findings and the operating time. The duration of the operations was evaluated among 3 time periods: group A = 10/2009 – 10/2010, group B = 11/2010 – 03/2012 and group C = 04/2012 – 06/2013.

Results: 269 patients received a TLH and 166 patients underwent a LASH. The duration of the operations was as follows: in group A 136 ± 59 min; in group B 117 ± 47 min and in group C 109 ± 56 min. The time reduction between the groups was significant and was demonstrated for both methods, TLH and LASH. A performed univariate linear regression analysis shows a significant correlation between operating time and patient's BMI, previous operations and complications such as blood loss, a shift towards laparotomy, urinary tract injury and the residence time.

Conclusion: Our findings should help other centers to understand the process of learning endoscopic procedures and to facilitate adopting minimal invasive strategies in gynecology.