Learning curves of total laparoscopic hysterectomies in three gynecologists

Oh, Yoon Kyung; Hwang, Hyo Soon; Yi, Kyung Wook; Song, Seung Hun; Lee, Jae Kwan; Hur, Jun Young; Shin, Jung Ho

Abstract

OBJECTIVE
Total laparoscopic hysterectomy (TLH) is becoming more commonly used as an alternative to traditional abdominal hysterectomy and Analyzing the turning point of a learning curve can be useful in planning training programs. This study was to define the average turning point of a learning curve of TLH by comparing three separate gynecologists in one institute.
METHODS
Retrospective analysis of the first 140 consecutive cases of TLH performed by three separate gynecologists A, B, and C. Patients of each gynecologist were divided into 7 equal groups of 20 operations classed chronologically. Patient's age, uterus weight, operation time and pre-post operative hemoglobin difference of the three gynecologists were compared. Operation time and pre-post operative hemoglobin difference were evaluated to build learning curves for each gynecologist.
RESULTS
Learning curve built by operation time showed turning point after 80~100 cases in all three gynecologists. Learning curve built by pre-post operative hemoglobin difference did not show a decreasing pattern. There were no statistical differences in patient's age and pre-post operative hemoglobin difference between the three gynecologists. However, mean uterine weight of gynecologist C was significantly lighter than that of gynecologist A and B. Operation time was significantly longer in cases by gynecologist C than in cases by A and B.
CONCLUSION
At least 80~100 cases of experience in TLH is needed for a gynecologist to reach the turning point of the learning curve. This result can be used as a guide to the training program of TLH.