Learning laparoscopic hysterectomy: analysis of different surgeons' individual learning curves

ObjectiveThe aim of this study was to examine the development of surgical skills among surgeons learning total laparoscopic hysterectomy (TLH), using differences in complication rates between surgeons with different levels of experience and analyzing the development of individual operating times. Study designThis retrospective, single-center cohort study included 576 total laparoscopic hysterectomy procedures conducted between January 2015 and December 2019 at the municipal hospital in Karlsruhe, Germany. All TLHs were performed by eight surgeons, two of whom were experienced and six inexperienced. Complications were graded using the Clavien-Dindo classification. ResultsNo differences in complication rates were seen between experienced and inexperienced surgeons. With growing numbers of procedures, most surgeons quickly became faster, leading to reduced operating times. However, experienced surgeons who had performed more than 100 procedures also became faster, not reaching a time plateau after adjustment for weight of the uterus, presurgery score, and adnexal score. ConclusionsLearning laparoscopic hysterectomy in routine practice is safe for patients, and surgeons rapidly become faster as growing numbers of procedures are performed. Operating times for experienced surgeons who have carried out more than 100 operations also improve, and a time plateau is not reached.

Automated summary

This retrospective cohort study aimed to examine the development of surgical skills among surgeons learning total laparoscopic hysterectomy (TLH) by comparing complication rates and individual operating times between surgeons with different levels of experience. The study included 576 TLH procedures performed between January 2015 and December 2019 at a municipal hospital in Germany. The results showed no differences in complication rates between experienced and inexperienced surgeons. As the number of procedures increased, most surgeons became faster, leading to reduced operating times. However, experienced surgeons who had performed over 100 procedures also improved their operating times, and a time plateau was not reached even after adjustment for various factors.