An evaluation of the resident learning curve in performing laparoscopic supracervical hysterectomies as compared with patient outcome: five-year experience.

STUDY OBJECTIVE

To compare surgical and postoperative results after laparoscopic supracervical hysterectomy between the first 2 cases and last 2 cases performed by each senior resident.

DESIGN

Retrospective, case-control study (Canadian Task Force classification II-B).

SETTING

University hospital.

PATIENTS

Two hundred six women underwent laparoscopic supracervical hysterectomy.

INTERVENTIONS

Charts were reviewed to determine length of surgery, operative and postoperative complications, and other surgical values. A comparison was made between the first 2 and last 2 cases of 25 chief residents.

MEASUREMENTS AND MAIN RESULTS

There was no statistically significant difference between the first 2 and last 2 patients of each resident in terms of age, indication for surgery, uterine mass, ethnicity, body mass index, or parity. There was a significant decrease in the mean time of the first 2 cases versus the last 2 cases: 201.4 minutes versus 137.2 minutes (p <.001). There was no significant difference in blood loss, change in hematocrit, length of hospital stay, and surgical or postoperative complications.

CONCLUSIONS

Laparoscopic supracervical hysterectomy is a technically challenging procedure that nevertheless can be learned quickly with rapid improvement in operative time and without undue risk to the patient. Since initially presenting these data in 2003, the senior residents are now getting twice the amount of exposure to this surgery. In addition, these data now include residents who were exposed to this type of surgery as junior residents. Although residents are beginning to have increased experience in performing laparoscopic supracervical hysterectomy before their chief year, there is still a significant difference in operative time from the initial 2 procedures to the last 2 procedures completed by a chief resident.