Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience
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Objective To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwentresidency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radicalhysterectomy (ARH). Methods We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervicalcancer 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 sumtechnique. Results The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeplydecreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001). Surgeon B, however, showed a gentleslope 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 showedthat tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidenceinterval, 1.187 to 18.352). Conclusion After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, evenwithout ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases andshowed a gentle slope of learning curve, taking less effort to initially perform LRH.
Abstract
Objective To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwentresidency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radicalhysterectomy (ARH). Methods We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervicalcancer 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 sumtechnique. Results The operating time in surgeon A started at 5 to 10 standard deviations of mean operating time and afterward steeplydecreased with operative experience (Pearson correlation coefficient=-0.508, P=0.001). Surgeon B, however, showed a gentleslope 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 showedthat tumor size (>4 cm) was significantly associated with increased operating time (P=0.027; odds ratio, 4.667; 95% confidenceinterval, 1.187 to 18.352). Conclusion After completing the residency- and fellowship-training course on gynecologic laparoscopy, gynecologic oncologists, evenwithout ARH experience, might reach an acceptable level of surgical proficiency in LRH after approximately 20 cases andshowed a gentle slope of learning curve, taking less effort to initially perform LRH.
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