Learning Curve Analysis and Surgical Outcomes of Single-port Laparoscopic Myomectomy

Abstract

Study objective: To identify learning curves for single-port laparoscopic myomectomy (SPLM) and evaluate surgical outcomes according to the sequence of operation.

Design: A retrospective study.

Setting: A university-based hospital (Canadian Task Force classification II-2).

Patients: The medical records from 205 patients who had undergone SPLM from October 2009 to May 2013 were reviewed. Because the myomectomy time was significantly affected by the size and number of myomas removed by SPLM, cases in which 2 or more of the myomas removed were >7 cm in diameter were excluded. Furthermore, cases involving additional operations performed simultaneously (e.g., ovarian or hysteroscopic surgery) were also excluded. A total of 161 cases of SPLM were included.

Interventions: None.

Measurements and main results: We assessed the SPLM learning curve via a graph based on operation time versus sequence of cases. Patients were chronologically arranged according to their surgery dates and were then placed into 1 of 4 groups according to their operation sequence. SPLM was completed successfully in 160 of 161 cases (99.4%). One case was converted to multiport surgery. Basal characteristics of the patients between the 4 groups did not differ. The median operation times for the 4 groups were 112.0, 92.8, 83.7, and 90.0 minutes, respectively. Operation time decreased significantly in the second, third, and fourth groups compared with that in the first group (p < .001). Proficiency, which is the point at which the slope of the learning curve became less steep, was evident after about 45 operations.

Conclusion: Results from the current study suggested that proficiency for SPLM was achieved after about 45 operations. Additionally, operation time decreased with experience without an increase in complication rate.

Keywords: Laparoendoscopic single-port surgery; Laparoscopic myomectomy; Myoma; Myomectomy; Single port.