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

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.

Resumo

Objetivo Avaliar o impacto do treinamento laparoscópico sistematizado de habilidades e sutura (TLSHS) nos resultados intra e pós-operatórios da histerectomia laparoscópica em um hospital universitário brasileiro.

Métodos Estudo observacional transversal de revisão de 244 prontuários de pacientes submetidas a histerectomia total laparoscópica (HTL) operadas entre 2008 e 2014. Os fatores específicos das pacientes (idade, paridade, cesariana prévia, cirurgias abdominais, e endometriose) e as variáveis relacionadas à cirurgia (tempo de hospitalização, tempo de cirurgia, volume uterino e complicações operatórias) foram analisados em três grupos temporais: 2008-09 (I-1) – HTLs realizadas por médicos experientes; 2010-11 (I-2) – HTLs realizadas por residentes sem TLSHS; 2012-2014 (I-3) – HTLs realizadas por residentes após a implementação do TLSHS.

Resultados Um total de 244 pacientes submetidas a HTLs foram incluídas (média de idade de 45,93 anos): 24 operadas no período I1, 55 no I2, e 165 no I3. A principal indicação para HTL foi mioma uterino (66,4%). O grupo I-3 apresentou diminuição no tempo cirúrgico quando comparado ao grupo I-2 (p = 0,010). Hospitalização superior a 2 dias diminuiu no grupo I-3 comparado ao grupo I-2 (p = 0,010). Apesar de observarmos diminuição no volume uterino dos pacientes do grupo I-2 (154,2 cm³) em comparação com os do grupo I-1 (217,8 cm³) (p = 0,030), a regressão logística não revelou associação entre volume uterino e tempo cirúrgico (p = 0,103).

Conclusão O tempo cirúrgico na HTL foi significativamente menor no grupo de pacientes submetidas à cirurgia após a implantação do TLSHS em nosso hospital.

Keywords

hysterectomy - laparoscopic surgery - education - suture training

Palavras-chave

histerectomia - cirurgia laparoscópia - educação - treinamento de sutura

Contributors

All authors contributed with the project and the interpretation of data, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.

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