The effect of the learning curve ion the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomy

Background. Hysterectomy is the commonest elective major gynecological operation and the laparoscopic approach is increasingly an option. We evaluated the influence of the; learning curve on the duration of surgery and also the peri-operative complications. Methods. A retrospective study of the case records of patients who had laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy between August 1993 and July 1997. Results. Over a four year period 86 cases of laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy were performed; the main indication being menstrual disorders. The mean duration of surgery was 116 minutes. There was a significant difference in the mean duration of surgery between the first two years (123 minutes) and the last two years (110 minutes) (P<0.02). The difference in the mean duration of surgery performed either by consultants or senior registrars under supervision (115 versus 116 minutes) was not significant (p>0.05). The overall complication rate was 16% with a majority; (85%) occurring in the first two years of the study period. Three cases (5%) were converted to conventional abdominal hysterectomy. After the initial learning phase there was a significant reduction in the complication rates. Conclusions. The impact of the learning curve on the duration of surgery is gradual. The perceived duration of surgery should not be a disincentive for senior trainees provided they are already proficient in minor laparoscopic surgery, cases are suitably selected and adequate supervision is provided.