EVALUATION AND THE LEARNING-CURVE OF THE FIRST 100 LAPAROSCOPIC HYSTERECTOMIES

Background. We analyzed the first one hundred laparoscopic hysterectom ies done by one senior gynecologist to study the learning curve and co mplications of this technique. Methods. One hundred laparoscopic hyste rectomies done for uterine fibroid (64%), menorrhagia (20%), adenomyos is or endometriosis (10%), cervical dysplasia (3%) and endometrial can cer (3%) were studied. Results. No conversion to laparotomy was needed . The weight of the uterus ranged from 70 to 470 grams (mean 206 g) an d the operating time ranged from 45 to 245 minutes (mean 109 min). The mean operating time was reduced from 180 to 75 minutes. The uterine w eight and the weight of the patient had a positive correlation to oper ating time. The use of automatic staplers or clips did not reduce the operating time. Ten complications occurred: one perforation of the uri nary bladder, five bleedings and four pelvic infections. Conclusion. T he operating time was clearly shortened during the first one hundred l aparoscopic hysterectomies. The rate of the complications did not fall similarly. Technical complications( bladder perforation and intraoper ative bleeding) occurred in the beginning. Complications like infectio n and bleeding do not seem to disappear with experience. Laparoscopic hysterectomy appears to be as safe as abdominal or vaginal hysterectom y and the postoperative convalescence time is short. It is clearly an acceptable alternative to hysterectomy.