Title: Prospective study of the learning process in adopting laparoscopic sacrocolpopexy
Authors: Claerhout, F
Cooremans, G
De Ridder, Dirk
Deprest, Jan #
Issue Date: Sep-2006
Publisher: Springer International
Host Document: International urogynecology journal vol:17 pages:245-246
Conference: IUGA edition:31 location:Athens, Greece date:2006
Article number: 339
Abstract: Objectives: Laparoscopy may reduce the morbidity of
sacrocolpopexy by open surgery but requires advanced
operative laparoscopic skills. The aim of this study is to
analyse the learning process for performing laparoscopic
sacrocolpopexy (LS) by a surgeon familiar with advance
laparoscopy but not with LS (trainee) with operation time
as a first outcome measure.
Materials and methods: Prior to the study the trainee
primed his suturing skills by 15 h of practicing endoscopic
suturing on an endotrainer. LS was empirically divided in
three parts: (1) dissection of the promontory, (2) of the
paracolic gutter and vagina and (3) fixation of the implant
to the vault and sacrum. The operation time, peri-operative
complication rate and performance (on a Visual Analogous
Scale :0–10) for each step were registered, analysed and
compared to those of the surgeon experienced in performing LS (>200 LS) referred to as teacher. In the first 30 procedures the trainee only performed step 1 and 2. The
trainee performed suturing and stapling (step 3) in the next
20; the study is ongoing.
Results: Between November 2003 and March 2006 50 patients were included. The dissection of the promontory by the trainee took 14.8±8.6 min which was no different from that of the teacher (12.4±9.7 min; ns). The mean time to dissect the vaginal vault was 42.4±16.7 min, significantly longer than that by the teacher (25±18.4 min, p<0.05). When procedures were analysed in blocks of 10, a decrease
in operation time to dissect the vault, by 10 min between
cases 1–10 and 21–30 could be demonstrated (48± 23.4→39.1±8.2; p<0.05). After 30 procedures the mean
operation time of the trainee remained 15 min longer than
that of the teacher (39.1±8.2; p<0.05) suggesting that—if
operation time is representative—the learning process was
not completed yet. The mean time it took the trainee to
suture the mesh to the vaginal vault was 55.9±15.5 min vs
40.4±15.5 for the teacher (p<0.05). When the first ten
procedures were compared to the last procedure 10, a
decrease in suturing time of 15 min could be demonstrated (63.8±15.9 vs 48.1±11.9; p<0.05; −26%). Although this
decrease was dramatical, it was still 8 min longer than of
the teacher (p<0.05). The performance score remained equal over the three studied steps of the operations. There were no intraoperative complications and one patient presented with a mesh erosion after 15 weeks. At the time of revision this was located at a place where the mesh was folded by a suture.
Conclusion: It takes a long time to achieve comparable
operation times by a trainee experienced with operative
laparoscopy. This applies to the total operation time,
dissection of the vault and the suturing. Even after 30
procedures there is still improvement, despite priming the
surgeon for suturing.
ISSN: 0937-3462
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Urology Section (-)
Basic Research in Gynaecology Section (-)
# (joint) last author

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