AAGL 2013: Maintaining Surgical Proficiency Is Just as Important as Achieving It


Data show that maintaining surgical proficiency results in better outcomes for laparoscopic hysterectomy. The magic number for maintenance: 20 procedures a year.

Achieving proficiency in minimally invasive surgery obviously is a key step in a surgeon’s ability to perform the surgery independently. However, maintaining proficiency seems to be just as important for a reduced complications rate and improved outcomes for laparoscopic hysterectomies, according to new research presented yesterday at the 42nd AAGL Global Congress on Minimally Invasive Gynecology, held just outside of Washington, DC, in National Harbor.

Noor Ahmed-Ebbiary, MD, of Queens Park Hospital in Lancashire, United Kingdom, presented the findings of a cohort study from a general hospital setting designed to assess the minimum number of laparoscopic hysterectomy procedures that a surgeon needs to complete each year to maintain proficiency and, thus, maximize outcomes. The outcomes of two patient groups who underwent either a total laparoscopic hysterectomy (TLH) or a laparoscopic-assisted vaginal hysterectomy (LAVH) because of abnormal periods and/or pelvic pain were compared. Group A consisted of 20 consecutive cases of TLH performed by a single surgeon who performs 20 or more such procedures each year. Group B consisted of 40 cases of LAVH, which represented 20 consecutive cases each for 2 different surgeons who perform less than 20 LAVH procedures in a 1-year period.

Overall, patients in group A compared with those in group B required less analgesia, had less blood loss, required no transfusion, had no need for a return to surgery, had a shorter length of hospital stay, and were less likely to have long-term complications despite TLH being a more technically difficult surgery than LAVH.

“Complications rate decreases and outcome improves if proficiency is maintained. Thus, surgical outcome largely depends on the number of laparoscopic hysterectomy procedures performed each year,” said Ahmed-Ebbiary. He went on to add that these findings suggest that performing a minimum of 20 such surgeries each year is associated with improved outcomes.

Although these findings cannot be applied to other surgeries, logic suggests that the patients of a proficient surgeon will have better outcomes than those of a surgeon who hasn’t maintained proficiency in a surgical technique.

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