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 oper ation and the laparoscopic approach is increasingly an option. We evaluated the influence of the; learning curve on the duration of surgery and also t he peri-operative complications. Methods. A retrospective study of the case records of patients who had lapa roscopically assisted vaginal hysterectomy with or without bilateral salpin go-oophorectomy between August 1993 and July 1997. Results. Over a four year period 86 cases of laparoscopically assisted vagi nal hysterectomy with or without bilateral salpingo-oophorectomy were perfo rmed; the main indication being menstrual disorders. The mean duration of s urgery was 116 minutes. There was a significant difference in the mean dura tion 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 surger y performed either by consultants or senior registrars under supervision (1 15 versus 116 minutes) was not significant (p>0.05). The overall complicati on 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 red uction 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 fo r senior trainees provided they are already proficient in minor laparoscopi c surgery, cases are suitably selected and adequate supervision is provided .