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Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience.

Kong TW, Chang SJ, Paek J, Park H, Kang SW, Ryu HS - Obstet Gynecol Sci (2015)

Bottom Line: The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001).Multivariate analysis showed that tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidence interval, 1.187 to 18.352).After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH.

View Article: PubMed Central - PubMed

Affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea. ; Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Objective: To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH).

Methods: We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divided into two groups (surgeon A group, 42 patients; surgeon B group, 42 patients) according to the surgeon with or without ARH experience. Clinico-pathologic data were analyzed between the 2 groups. Operating times were analyzed using the cumulative sum technique.

Results: The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001). Surgeon B, however, showed a gentle slope of learning curve within 2 standard deviations of mean operating time (Pearson correlation coefficient=-0.225, P=0.152). Approximately 18 cases for both surgeons were required to achieve surgical proficiency for LRH. Multivariate analysis showed that tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidence interval, 1.187 to 18.352).

Conclusion: After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH.

No MeSH data available.


Related in: MedlinePlus

Surgical specimens of laparoscopic radical hysterectomy. (A) Surgeon A and (B) surgeon B.
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Figure 1: Surgical specimens of laparoscopic radical hysterectomy. (A) Surgeon A and (B) surgeon B.

Mentions: There were no significant differences in histopathologic type, grade, pathologic tumor size, length of parametrium and vaginal cuff, and pathologic risk features between the two groups (Table 2). The mean numbers of pelvic and para-aortic LNs retrieved were 22.0 and 8.9 in the surgeon A group, and 23.0 and 10.0 in the surgeon B group, respectively (pelvic LNs, P=0.189; para-aortic LNs, P=0.403). The mean pathologic tumor size was 27.0 mm (range, 10 to 60 mm) in the surgeon A group and 29.0 mm (range, 10 to 70 mm) in the surgeon B group. Adequate margins of paracervical and vaginal cuff resection were achieved through LRH (Fig. 1).


Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience.

Kong TW, Chang SJ, Paek J, Park H, Kang SW, Ryu HS - Obstet Gynecol Sci (2015)

Surgical specimens of laparoscopic radical hysterectomy. (A) Surgeon A and (B) surgeon B.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588842&req=5

Figure 1: Surgical specimens of laparoscopic radical hysterectomy. (A) Surgeon A and (B) surgeon B.
Mentions: There were no significant differences in histopathologic type, grade, pathologic tumor size, length of parametrium and vaginal cuff, and pathologic risk features between the two groups (Table 2). The mean numbers of pelvic and para-aortic LNs retrieved were 22.0 and 8.9 in the surgeon A group, and 23.0 and 10.0 in the surgeon B group, respectively (pelvic LNs, P=0.189; para-aortic LNs, P=0.403). The mean pathologic tumor size was 27.0 mm (range, 10 to 60 mm) in the surgeon A group and 29.0 mm (range, 10 to 70 mm) in the surgeon B group. Adequate margins of paracervical and vaginal cuff resection were achieved through LRH (Fig. 1).

Bottom Line: The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001).Multivariate analysis showed that tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidence interval, 1.187 to 18.352).After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH.

View Article: PubMed Central - PubMed

Affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea. ; Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Objective: To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH).

Methods: We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divided into two groups (surgeon A group, 42 patients; surgeon B group, 42 patients) according to the surgeon with or without ARH experience. Clinico-pathologic data were analyzed between the 2 groups. Operating times were analyzed using the cumulative sum technique.

Results: The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeply decreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001). Surgeon B, however, showed a gentle slope of learning curve within 2 standard deviations of mean operating time (Pearson correlation coefficient=-0.225, P=0.152). Approximately 18 cases for both surgeons were required to achieve surgical proficiency for LRH. Multivariate analysis showed that tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidence interval, 1.187 to 18.352).

Conclusion: After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, even without ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases and showed a gentle slope of learning curve, taking less effort to initially perform LRH.

No MeSH data available.


Related in: MedlinePlus