The Power Law of Learning in Transumbilical Single-Port Laparoscopic Subtotal Hysterectomy
| Autor: | Chyi-Long Lee, Chen-Ying Huang, Hsuan Su, Shu-Han You, Chien-Min Han, Chih-Feng Yen |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Operative Time Tissue Adhesions Single-port laparoscopy Hysterectomy Subtotal hysterectomy 03 medical and health sciences 0302 clinical medicine Port (medical) medicine Humans Prospective Studies Major complication Uterine Diseases 030219 obstetrics & reproductive medicine business.industry Obstetrics and Gynecology Laparoscopic subtotal hysterectomy Surgery 030220 oncology & carcinogenesis Operative time Female Laparoscopy Observational study business Body mass index Learning Curve |
| Zdroj: | Journal of Minimally Invasive Gynecology. 25:994-1001 |
| ISSN: | 1553-4650 |
| Popis: | Study Objective To analyze the surgical outcomes and learning curve of transumbilical single-port laparoscopic subtotal hysterectomy, which requires sutures of the cervical stump. Design A prospective observational study (Canadian Task Force classification II-2). Setting A university-affiliated center. Patients From the first (July 2012) and consecutive patients of benign uterine disease scheduled for subtotal hysterectomy until October 2013. Interventions All single-port laparoscopies were performed using straight instruments by 1 gynecologist. An ancillary port was added whenever technical difficulties could endanger surgical quality. Measurement and Main Results Seventy-five patients were recruited for intention-to-treat analysis with a mean (±SD) age of 44.7 ± 3.8 years and a body mass index of 24.2 ± 3.7 kg/m 2 . No major complication was noted. The mean uterine weight was 432.5 ± 344.0 g with 24 (32%) uteri ≧500 g. The patients' sequential order, or gradually increasing experience, was the determining factor in progressively decreasing operative time. Furthermore, most cases that required an additional ancillary port (67%) were clustered in the first 20 cases, whereas 4 were scattered after the 47th patient because of severe pelvic adhesion. The mean operative time decreased in the power law function of the patients' sequential order with a plateau achieved at the 20th patient. Conclusion The patients' sequential order was identified as an independent factor of achieving purely single-port access, and the trend of decreasing operative time delineated the existence of a learning curve. Approximately 20 patients were needed for an experienced multiport laparoscopist to reach technical competency in the current series. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|