Morbidity of 10 110 hysterectomies by type of approach

Implementing an Advanced Laparoscopic Procedure by Monitoring with a Visiting Surgeon

“…Altgassen et al [7] reported that most complications occur in the first 30 procedures, with a decrease in intraoperative major complications thereafter, from 4.2% (10 of 240 procedures) to 0.5% (2 of 428 procedures); postoperative complications decreased from 1.3% (3 of 240 procedures) to 0.5% (2 of 428 procedures). A study by Mäkinen et al [8] also described a significant drop in intraoperative major complications (ureter, bladder, and bowel lesions), from 4.6% to 1.6% (in a total of 2434 patients) when the surgeon had performed more than 30 LH procedures compared with those who had performed fewer than 30 procedures. Our Table 3 Characteristics of 166 study patients intraoperative complication rate during the learning curve was 2.4% (2 of 83 procedures), and after the learning curve was 3.6% (3 of 83 procedures); postoperative major complications during the learning curve were 1.2%, and after the learning curve were 2.4%.…”

“…A correlation between OSATS-score and complications during the surgical procedure was not found in this study and has not been described in the literature. There is, however, a correlation between the learning curve of a surgical procedure and the complication rate, i.e., in earlier studies [7][8][9][10] more complications are reported during than after the learning curve. Especially during training, objective assessment and structured feedback is essential to correct deficiencies [32].…”

“…Major complication rates ranging from 1.2% to 11.1% have been reported in studies of LH [7,8,10,17,18]. Wattiez et al [10] noted that major complications occurred in 39 of 695 LH procedures (5.6%) performed by a surgeon in the first 6 years compared with 12 in 953 LH procedures (1.3%) in the 3 years thereafter.…”

“…First, the learning curve for LH is long, varying from 3 to 10 years or 20 to 30 procedures, according to several studies [7][8][9][10], and most major complications occur during this learning curve [7][8][9][10]. Second, LH is a level 3 laparoscopic procedure that demands a high level of surgeon laparoscopic skills; however, most gynecologists are taught level 1 and 2 laparoscopic procedures during their training [11].…”

Laparoscopic hysterectomy and ureteric injury: a comparison of the initial 275 cases and the last 1,000 cases using staples

“…Garry et al found that: "The method used to secure the blood vessel pedicles did appear to influence the rate of complications with the lowest risk apparently associated with securing vascular pedicles with diathermy or staples rather than sutures [25]. " Makinen et al [26] in a review of 10,110 hysterectomies in Finland found that ureteric injuries at laparoscopic hysterectomy were 4.4 times more common with surgeons who had performed 30 procedures or fewer than with surgeons who had performed more than 30 (incidence: 2.2 vs. 0.5%). Wattiez et al [27] had significantly more renal tract injuries in their first 695 laparoscopic hysterectomies than in the subsequent 952, with ureteric injuries falling by almost two-thirds from 0.58 to 0.21%.…”