The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

Usturalı Mut, Ayşe Nur; ALBAYRAK, Mustafa; keskin, fatih; Biyik, Ismail

The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

İSMAİL BIYIK, (Karacabey Devlet Hastanesi, Bursa, Türkiye)

Mustafa ALBAYRAK, (Özel Meydan Hastanesi, Şanlıurfa, Türkiye)

Fatih KESKİN, (Sultan 1. Murat Devlet Hastanesi, Edirne, Türkiye)

Ayşe Nur MUT (Ankara Üniversitesi Tıp Fakültesi, Epidemiyoloji Anabilim Dalı, Ankara, Türkiye)

GORM:Gynecology Obstetrics & Reproductive Medicine

6 0

Yıl: 2020 Cilt: 26 Sayı: 2 Sayfa Aralığı: 134 - 139 Metin Dili: İngilizce İndeks Tarihi: 25-11-2020

The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

Öz:

OBJECTIVES: Online education and certification programs which help most gynecologic surgeons to advance, improve and prove their skills. However, the benefits of such distant programs in terms of complication rate and operation time has not been evaluated so far. The aim of this study was to report the improvement of a single surgeon’s learning curve in total laparoscopic hysterectomy who had no previous mentorship/fellowship education, working in a rural district hospital before and after the completion of a distant on-line education and certification program - Gynaecological Endoscopic Surgical Education and Assessment. STUDY DESIGN: Medical records of patients who underwent total laparoscopic hysterectomy between May 2015 and December 2018 were retrospectively reviewed and grouped based on the certification date of the surgeon, Group 1 before and Group 2 after certification. Groups were compared for variables that impact the learning curve (operation time, complications and conversion to laparotomy) RESULTS: Of the 57 women eligible for evaluation 30 had total laparoscopic hysterectomy in Group 1 and 27 had total laparoscopic hysterectomy in Group 2. BMI, number of vaginal/cesarean births, previous abdominal/pelvic surgeries, operation indications, uterine weight, adnexectomy, and adhesiolysis rates, transfusion requirements, and the decrease in hemoglobin before and after operation were similar between the groups (p>0.05). Operation time was significantly shorter in Group 2 (83 min vs.116 min, p<0.0001). CONCLUSION: Thirty total laparoscopic hysterectomy operations seem enough to reach a plateau in the learning curve for gynecologists working in rural areas with limited facilities who cannot afford lengthily and expensive fellowship/mentorship programs, after completing distant online certification programs.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Garry R. The future of hysterectomy. BJOG. 2005;112 (2): 133-9.
2. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011;18(1):1-3.
3. Cohen SL, Vitonis AF, Einarsson JI. Updated hysterectomy surveillance: factors associated with minimal invasive hysterectomy. JSLS. 2014;18(3). pii: e2014.00096.
4. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ. 2005; 330(7506):1478.
5. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;(3):CD003677.
6. Bijen CB, Vermeulen KM, Mourits MJ, de Bock GH. Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials. PLoS One. 2009;4(10):e7340.
7. Subramonian K, Muir G. The “learning curve” in surgery: what is it, how do we measure it and can we influence it? BJU Int. 2004;93(9):1173-4.
8. Wattiez A, Soriano D, Cohen SB, Nervo P, Canis M, Botchorishvili R, et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc. 2002;9(3):339-45.
9. Clark NV, Gujral HS, Wright KN. Impact of a fellowshiptrained minimally invasive gynecologic surgeon on patient outcomes. JSLS. 2017;21(3). pii: e2017.00037.
10. Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A. To tal laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg. 2016;35: 51-7.
11. Garrett A.J, Nascimento MC, Nicklin JL, Perrin LC, Obermair A. Total laparoscopic hysterectomy: the Brisbane learning curve. Aust N Z J Obstet Gynaecol. 2007;47(1):65-9.
12. Rosen DMB, Cario GM, Carlton MA, Lam AM, Chapman M. An assessment of the learning curve for laparoscopic and total laparoscopic hysterectomy. Gynaecological Endoscopy. 1998;7(6):289-93.
13. Agarwal P, Bindal N, Yadav R. Risks and benefits of total laparoscopic hysterectomy and the effect of learning curve on them. J Obstet Gynaecol India. 2016;66(5):379-84.
14. Mavrova R, Radosa JC, Wagenpfeil G, Hamza A, Solomayer EF, Juhasz-Böss I. Learning curves for laparoscopic hysterectomy after implementation of minimally invasive surgery. Int J Gynaecol Obstet. 2016;134(2):225-30.
15. Twijnstra AR, Blikkendaal MD, Kolkman W, Smeets MJ, Rhemrev JP, Jansen FW. Implementation of laparoscopic hysterectomy: maintenance of skills after a mentorship program. Gynecol Obstet Invest. 2010;70(3):173-8.
16. Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study. BJOG. 2010;117(6):752-5.
17. Karaman Y, Bingol B, Günenç Z. Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol. 2007;14(1):78-84.

APA	Biyik I, ALBAYRAK M, keskin f, Usturalı Mut A (2020). The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. , 134 - 139.
Chicago	Biyik Ismail,ALBAYRAK Mustafa,keskin fatih,Usturalı Mut Ayşe Nur The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. (2020): 134 - 139.
MLA	Biyik Ismail,ALBAYRAK Mustafa,keskin fatih,Usturalı Mut Ayşe Nur The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. , 2020, ss.134 - 139.
AMA	Biyik I,ALBAYRAK M,keskin f,Usturalı Mut A The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. . 2020; 134 - 139.
Vancouver	Biyik I,ALBAYRAK M,keskin f,Usturalı Mut A The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. . 2020; 134 - 139.
IEEE	Biyik I,ALBAYRAK M,keskin f,Usturalı Mut A "The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital." , ss.134 - 139, 2020.
ISNAD	Biyik, Ismail vd. "The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital". (2020), 134-139.

APA	Biyik I, ALBAYRAK M, keskin f, Usturalı Mut A (2020). The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. GORM:Gynecology Obstetrics & Reproductive Medicine, 26(2), 134 - 139.
Chicago	Biyik Ismail,ALBAYRAK Mustafa,keskin fatih,Usturalı Mut Ayşe Nur The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. GORM:Gynecology Obstetrics & Reproductive Medicine 26, no.2 (2020): 134 - 139.
MLA	Biyik Ismail,ALBAYRAK Mustafa,keskin fatih,Usturalı Mut Ayşe Nur The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. GORM:Gynecology Obstetrics & Reproductive Medicine, vol.26, no.2, 2020, ss.134 - 139.
AMA	Biyik I,ALBAYRAK M,keskin f,Usturalı Mut A The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. GORM:Gynecology Obstetrics & Reproductive Medicine. 2020; 26(2): 134 - 139.
Vancouver	Biyik I,ALBAYRAK M,keskin f,Usturalı Mut A The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital. GORM:Gynecology Obstetrics & Reproductive Medicine. 2020; 26(2): 134 - 139.
IEEE	Biyik I,ALBAYRAK M,keskin f,Usturalı Mut A "The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital." GORM:Gynecology Obstetrics & Reproductive Medicine, 26, ss.134 - 139, 2020.
ISNAD	Biyik, Ismail vd. "The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital". GORM:Gynecology Obstetrics & Reproductive Medicine 26/2 (2020), 134-139.