Abstract

SURGICAL LEARNING CURVE IN LAPAROSCOPIC HYSTERECTOMY: RETROSPECTIVE ANALYSIS OF 169 CASES IN A MOROCCAN TEACHING HOSPITAL

Loubna Slama*, Ikram Asakak, Zaineb Chatbi, Ibtissam Bellajdel, Hafsa Taheri, Hanane Saadi and Ahmed Mimouni

Abstract

The superiority of vaginal surgery and laparoscopy over laparotomy for benign uterine pathologies is well established, while the superiority of laparoscopy over the vaginal route remains controversial. However, when performed by an experienced surgeon following a learning curve, complications become nearly identical in terms of frequency, with the choice of approach often following the surgeon's preference. Objective: To evaluate the implementation of laparoscopic hysterectomy and the evolution of the surgeon’s skills in a Moroccan university center. Methodology: This study is a retrospective analysis of the learning curve of laparoscopic hysterectomy in a teaching hospital during its first 169 cases. Patients were divided into two groups: the first 89 cases (group A) and the last 80 cases (group B). Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operative time, intraoperative bleeding, complications, need for transfusion, and length of hospital stay were compared. Results: Laparoscopic hysterectomies were performed using the conventional 10-step technique. Ninety percent were total hysterectomies, 30% included bilateral adnexectomy, and 49% included bilateral salpingectomy. The indications were primarily abnormal uterine bleeding (56%), hemorrhagic myomas (21%), and endometrial hyperplasia (10%). The average operative time significantly decreased from 165 to 80 minutes between the two groups (p

Keywords: Four conversions to laparotomy were reported.