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Impact of laparoscopic sacrocolpopexy learning curve on operative time, perioperative complications and short term results.

Eur J Obstet Gynecol Reprod Biol. 2015 Aug;191:84-9. doi: 10.1016/j.ejogrb.2015.05.013. Epub 2015 May 30.

David V, Géraldine G, Jean-Philippe L, Hélène B, Michel C.
Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France. Electronic address: vdddv@live.fr.2Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, France.3Methodology and Biostatistics Unit, EA2694, UDSL2, University Lille Nord de France, University Hospital of Lille, France.
Eur J Obstet Gynecol Reprod Biol
ABSTRACT
AbstractOBJECTIVE: Laparoscopic sacrocolpopexy (LSCP) learning is a challenge for unexperienced surgeons, since complications occurrence and anatomical results could depend from surgeon’s experience. The aim of this study was to describe LSCP characteristics, perioperative complications and short term anatomical results when LSCP was performed by LSCP-experienced surgeons or trainees.STUDY DESIGN: Patients who underwent LSCP in our surgical unit in the last ten years were included. Patients were excluded if laparotomy was performed without any laparoscopic time. Interventions were divided into LSCP experienced surgeons (who had performed at least 30 procedures) and trainees (residents, fellows, and surgeons with less than 30 procedures). Main outcomes were operative time, peroperative complications (included conversions to open or vaginal surgery, bladder and vaginal perforation, epigastric vessels injury and hemorrhage) early postoperative complications, mesh complications and anatomical results at three months.RESULTS: 492 patients were included, 108 in the trainee group and 384 in the LSCP-experienced group. Groups were comparable for demographics, preoperative clinical examination and surgery characteristics. Average operative time was significantly higher in trainees group than in LSCP-experienced group (251 versus 178 min (p<0.0001)). There was no difference in open surgery conversion rate (5.6% versus 3.9%, p=0.42) or peroperative complication occurrence (4.7% versus 4.6%, p=0.98). Bladder perforations were more frequent in trainee group but difference was not statistically significant (3.7% versus 1.3%, p=0.11). 98% patients were assessed at three months. Overall anatomical success rate was 94.9%. There was no difference in anatomical failure rate between trainee group and LSCP experienced surgeons group (respectively 4.7% versus 5.2%, p=0.82), neither in mesh complication rate (3.9% versus 2.8%, p=0.77).CONCLUSION: LSCP learning in an experimented surgical team induces high operative time, but remains safe for patient.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:26094181 | http://www.ncbi.nlm.nih.gov/pubmed/26094181

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