Skip to main content
SpringerLink
Log in

In Laparoscopic Myomectomy, Does a Caseload of 100 Patients During the Learning Curve Produce a Significant Improvement in Performance Measures?

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic myomectomy (LM) offers considerable advantages over open myomectomy; however, LM is technically complex and associated with a steep learning curve. Few studies have evaluated the effect of the learning curve, and the limitations of most of these studies were the number of women included and the multiplicity of surgeons undertaking the procedure. The aim of this study is to evaluate the effect of a caseload of 100 patients during the learning curve of a single experienced surgeon performing LM.

Methods

A prospective comparative analysis of 200 consecutive cases of LM was conducted between December 2004 and March 2013. Outcomes of the first 100 procedures (Group A) were compared with the later 100 (Group B).

Results

The mean age of the cohort was 39 years (24–54 years), with a mean BMI of 27 kg/m2 (16–46). Both the groups were very similar with regard to the number, size and weight of myomas removed, the duration of surgery, and blood loss. More women were sent home within 24 h in the second group (27 vs 10.2 %, p = 0.002). Group A suffered significantly higher complication rates compared to Group B (11 vs 7, p < 0.05). The laparotomy conversion rate was 1.5 % (3 in Group A, none in Group B).

Conclusions

After a caseload of 100 patients during the learning curve, there was no difference in outcomes apart from increased confidence to discharge patients after 24 h and reduced complication rates. Thus, mere numbers do not influence the number/size of fibroids removed, operating time, or blood loss but do influence complication rates and post-operative discharge times.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–7.

    Article  PubMed  Google Scholar 

  2. Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90(6):967–73.

    Article  CAS  PubMed  Google Scholar 

  3. Rosati P, Bellati U, Exacoustos C, et al. Uterine myoma in pregnancy: ultrasound study. Int J Gynaecol Obstet. 1989;28(2):109–17.

    Article  CAS  PubMed  Google Scholar 

  4. Hasan F, Arumugam K, Sivanesaratnam V. Uterine leiomyomata in pregnancy. Int J Gynaecol Obstet. 1991;34(1):45–8.

    Article  CAS  PubMed  Google Scholar 

  5. Verkauf BS. Changing trends in treatment of leiomyomata uteri. Curr Opin Obstet Gynecol. 1993;5(3):301–10.

    Article  CAS  PubMed  Google Scholar 

  6. Garcia CR. Management of the symptomatic fibroid in women older than 40 years of age. Hysterectomy or myomectomy? Obstet Gynecol Clin North Am. 1993;20(2):337–48.

    CAS  PubMed  Google Scholar 

  7. Pundir J, Krishnan N, Siozos A, et al. Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri. Eur J Obstet Gynecol Reprod Biol. 2013;167(2):219–24.

    Article  CAS  PubMed  Google Scholar 

  8. Hasson HM, Rotman C, Rana N, et al. Laparoscopic myomectomy. Obstet Gynecol. 1992;80(5):884–8.

    CAS  PubMed  Google Scholar 

  9. Dubuisson JB, Chapron C. Uterine fibroids: place and modalities of laparoscopic treatment. Eur J Obstet Gynecol Reprod Biol. 1996;65(1):91–4.

    Article  CAS  PubMed  Google Scholar 

  10. Nezhat F, Seidman DS, Nezhat C, et al. Laparoscopic myomectomy today. Why, when and for whom? Hum Reprod. 1996;11(5):933–4.

    Article  CAS  PubMed  Google Scholar 

  11. Mais V, Ajossa S, Guerriero S, et al. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996;174(2):654–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril. 2005;83(1):1–23.

    Article  PubMed  Google Scholar 

  13. Jin C, Hu Y, Chen XC, et al. Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):14–21.

    Article  PubMed  Google Scholar 

  14. Dubuisso JB, Fauconnier A, Babaki-Fard K, et al. Laparoscopic myomectomy: a current view. Hum Reprod Update. 2000;6(6):588–94.

    Article  CAS  PubMed  Google Scholar 

  15. Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J. 2007;83(986):777–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Song SJ, Kim CH, Kim SH, et al. Learning curve of laparoscopic myomectomy. Korean J Obstet Gynecol. 2003;46(12):2345–51.

    Google Scholar 

  17. Kikuchi I, Kumakiri J, Matsuoka S, et al. Learning curve of minimally invasive two-port laparoscopic myomectomy. JSLS. 2012;16(1):112–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sankaran S, Odejinmi F. Prospective evaluation of 125 consecutive laparoscopic myomectomies. J Obstet Gynaecol. 2013;33(6):609–12.

    Article  CAS  PubMed  Google Scholar 

  19. Landi S, Zaccoletti R, Ferrari L, et al. Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations. J Am Assoc Gynecol Laparosc. 2001;8(2):231–40.

    Article  CAS  PubMed  Google Scholar 

  20. Rossetti A, Sizzi O, Chiarotti F, et al. Developments in techniques for laparoscopic myomectomy. JSLS. 2007;11(1):34–40.

    PubMed  PubMed Central  Google Scholar 

  21. Pandey V, Wolfe JH, Moorthy K, et al. Technical skills continue to improve beyond surgical training. J Vasc Surg. 2006;43(3):539–45.

    Article  PubMed  Google Scholar 

  22. Marret H, Chevillot M, Giraudeau B. Study Group of the French Society of G, Obstetrics. Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy. Acta Obstet Gynecol Scand. 2006;85(3):324–9.

    Article  CAS  PubMed  Google Scholar 

  23. Glasser MH. Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol. 2005;12(3):275–83.

    Article  PubMed  Google Scholar 

  24. Kimball BP, Bui S, Cohen EA, et al. Early experience with directional coronary atherectomy: documentation of the learning curve. Can J Cardiol. 1993;9(2):177–85.

    CAS  PubMed  Google Scholar 

  25. Prakash K, Kamalesh NP, Pramil K, et al. Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections. J Minimal Access Surg. 2013;9(3):99–103.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of medicine, Imperial College London, Imperial College Road, London, SW7 2AZ, UK

    Savan Shah

  2. Department of Obstetrician and Gynaecologist, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, E11 1NR, UK

    Jimi F. Odejinmi

  3. Department of Obstetrician and Gynaecologist, North West London Hospital NHS Trust, Northwick Park Hospital, Watford Road, London, HA1 3UJ, UK

    Nilesh Agarwal

Authors
  1. Savan Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jimi F. Odejinmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nilesh Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Savan Shah.

Ethics declarations

Conflict of interest

Savan Shah, Nilesh Agarwal, and Jimi Funlayo Odejinmi declare that they have no conflicts of interest.

Ethical approval

The study did not require any formal ethics approval as it was a review of ongoing practice. However, informal approval was sought from the appropriate institutional research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent from patients is not required.

Additional information

Savan Shah is a Medical Student in the Faculty of Medicine, Imperial College London, London, UK; Jimi F. Odejinmi is a Consultant Obstetrician and Gynecologist in the Department of Obstetrician and Gynecologist, Whipps Cross University Hospital, London, UK; Nilesh Agarwal is a Consultant Obstetrician and Gynecologist in the Department of Obstetrician and Gynecologist, North West London Hospital NHS Trust, London, UK.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, S., Odejinmi, J.F. & Agarwal, N. In Laparoscopic Myomectomy, Does a Caseload of 100 Patients During the Learning Curve Produce a Significant Improvement in Performance Measures?. J Obstet Gynecol India 66 (Suppl 1), 422–427 (2016). https://doi.org/10.1007/s13224-015-0782-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-015-0782-x

Keywords

Search

Navigation