CHRU de Strasbourg, Pôle de Gynécologie-Obstétrique, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France.
Eur J Obstet Gynecol Reprod Biol. 2010 Apr;149(2):218-21. doi: 10.1016/j.ejogrb.2009.12.012. Epub 2010 Jan 21.
The widespread diffusion of laparoscopic sacrocolpopexy in the management of female genital organ prolapse is hampered by its presumed length and technical difficulties. The aim of our study was to analyse the learning curve of a senior urogynecologic surgeon who was initiated into this technique.
The first 48 laparoscopic sacrocolpopexies performed by the same surgeon were analysed retrospectively for pre-operative, operative and post-operative data. At the time of the study, patients were asked about their degree of satisfaction by an anonymous questionnaire. To discover a turning point, the duration of each procedure was reported and the study population was divided into 8 equal groups of 6 interventions each, classed chronologically. Statistical analysis was carried out by Mauchly's sphericity test and then by Student-Newman-Keul's test. Other descriptive statistics were computed with the use of standard methods for means, medians and proportions.
The mean operative time was of 236.9 min. The learning curve showed a linear decrease in the duration of surgery with a turning point after 18-24 procedures (p<0.001). It was marked by 2 (4.1%) minor operative complications (2 cystostomies) and 2 immediate post-operative ones: one port-site hernia and one case of urinary retention. At 1 month, 1 patient (2.2%) presented an erosion of the posterior mesh. The mean follow-up was of 15.8 months. During this period, 2 patients (4.1%) presented with a recurrence of prolapse and 6 (12.5%) with de novo stress urinary incontinence. Forty-five patients (93.7%) answered an anonymous questionnaire regarding satisfaction: 40/45 (88.8%) were totally satisfied, 4 (8.8%) moderately and 1 (2.2%) not satisfied.
The learning curve of laparoscopic sacrocolpopexy shows a steady decrease in the duration of surgery. A turning point is observed after 18-24 procedures. During the learning curve there is no increased morbidity. Anatomical and functional results at short and medium terms are similar to those reported in the literature.
腹腔镜骶骨阴道固定术在女性生殖道脱垂管理中的广泛应用受到其预期长度和技术难度的阻碍。本研究的目的是分析一位接受该技术培训的资深妇科泌尿科医生的学习曲线。
回顾性分析同一位医生完成的前 48 例腹腔镜骶骨阴道固定术的术前、术中及术后数据。在研究时，通过匿名问卷询问患者的满意度。为了发现转折点，报告了每个手术的持续时间，并将研究人群按时间顺序分为 8 组，每组 6 例。通过 Mauchly 球形检验和学生-纽曼-凯斯检验进行统计分析。其他描述性统计数据使用均值、中位数和比例的标准方法进行计算。
平均手术时间为 236.9 分钟。学习曲线显示手术持续时间呈线性下降，转折点在 18-24 例手术后（p<0.001）。手术过程中有 2 例（4.1%）轻微并发症（2 例膀胱造口术）和 2 例即刻术后并发症：1 例切口疝和 1 例尿潴留。术后 1 个月，1 例（2.2%）患者出现后网片侵蚀。平均随访时间为 15.8 个月。在此期间，2 例（4.1%）患者出现脱垂复发，6 例（12.5%）患者出现新的压力性尿失禁。45 例患者（93.7%）回答了一份关于满意度的匿名问卷：40/45（88.8%）患者非常满意，4 例（8.8%）满意，1 例（2.2%）不满意。
腹腔镜骶骨阴道固定术的学习曲线显示手术持续时间稳步下降。转折点出现在 18-24 例手术后。在学习曲线期间，发病率没有增加。短期和中期的解剖和功能结果与文献报道相似。
