Our Summary

This study looked at how quickly two surgeons could learn to perform a total laparoscopic hysterectomy (a type of surgery to remove the uterus). They tracked their first 257 surgeries, splitting them into three groups: the first 75, the next 75, and the last 107. They looked at several factors including age, body mass index, reason for surgery, previous surgeries, surgery time, blood loss, complications, need for blood transfusion, and length of hospital stay.

They found that the average surgery time dropped from about 76 minutes to about 69 minutes between the first and second group. They also found that the surgeons seemed to reach a point where they weren’t improving much after about 70-80 surgeries. The rate of complications also fell from 8% in the first group to 4.7% in the last group. However, this drop wasn’t significant enough to say it definitely wasn’t due to chance. The need for blood transfusions did significantly drop between the first and second groups.

The study concluded that there seems to be a learning curve for this type of surgery, with surgeons getting better the more they do up to a point. However, it’s important to remember that this surgery can still have complications, even once the surgeon is experienced.

FAQs

  1. How many surgeries does it generally take for surgeons to reach the peak of their learning curve in total laparoscopic hysterectomy?
  2. Did the rate of complications significantly decrease with the increase in the number of surgeries performed by the surgeons?
  3. Was there a significant drop in the need for blood transfusions between the first and second groups of surgeries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic hysterectomy is to choose a surgeon who has experience and expertise in performing this specific type of surgery. It’s important to ask your surgeon about their experience with laparoscopic hysterectomies and inquire about their complication rates and patient outcomes. Additionally, following your surgeon’s pre-operative and post-operative instructions will help optimize your recovery and minimize the risk of complications. Finally, maintaining open communication with your healthcare team and asking any questions or expressing any concerns you may have throughout the process is key to ensuring the best possible outcome.

Suitable For

Typically, patients who are recommended for laparoscopic hysterectomy are those who have conditions such as uterine fibroids, endometriosis, abnormal uterine bleeding, pelvic pain, or certain types of cancer. Patients who have tried other treatment options that have not been successful may also be recommended for this type of surgery. Additionally, patients who are looking for a minimally invasive surgical option with faster recovery times and less scarring may also be good candidates for laparoscopic hysterectomy.

Timeline

Before laparoscopic hysterectomy:

  1. Patient consults with gynecologist to discuss options for treatment of conditions such as fibroids, endometriosis, or abnormal bleeding.
  2. Patient undergoes pre-operative testing such as blood work, imaging studies, and possibly a biopsy.
  3. Patient is instructed on pre-operative preparations such as fasting and medication adjustments.
  4. Patient arrives at the hospital or surgical center on the day of surgery and undergoes anesthesia induction.

After laparoscopic hysterectomy:

  1. Patient wakes up in the recovery room and is monitored closely for any complications.
  2. Patient is given pain medication and instructions on how to care for themselves post-operatively.
  3. Patient may experience some vaginal bleeding, cramping, and bloating in the days following surgery.
  4. Patient is discharged from the hospital typically within 1-2 days after surgery.
  5. Patient follows up with their surgeon for a post-operative appointment to discuss recovery progress and any concerns.
  6. Patient gradually resumes normal activities and may experience improvements in symptoms such as pelvic pain and heavy bleeding.

What to Ask Your Doctor

  1. How many laparoscopic hysterectomies have you performed?
  2. What is your complication rate for this procedure?
  3. What is your experience with handling potential complications during surgery?
  4. What is your approach to pain management after the surgery?
  5. How long will the recovery process be and what can I expect in terms of post-operative care?
  6. Are there any specific risks or potential side effects associated with this procedure that I should be aware of?
  7. Will there be any restrictions on my physical activity or lifestyle after the surgery?
  8. How will the surgery impact my hormone levels and menopausal symptoms?
  9. Are there any alternative treatment options that I should consider before opting for a laparoscopic hysterectomy?
  10. What should I do to prepare for the surgery and what can I do to optimize my chances for a successful outcome?

Reference

Authors: Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A. Journal: Int J Surg. 2016 Nov;35:51-57. doi: 10.1016/j.ijsu.2016.09.010. Epub 2016 Sep 12. PMID: 27633451