Laparoscopic hysterectomy: Does quantity improve quality?

March 30, 2012

Although the amount of experience a surgeon has in laparoscopic hysterectomy is directly associated with the quality of the outcomes, intrinsically good surgical skills may be a bigger factor.

Greater surgical experience is associated with less blood loss, fewer adverse events, and less operative time.

The current notion that 30 surgeries is the threshold for surgical proficiency in a given procedure may set the bar too low.

The higher the number of surgical procedures performed, the better the outcome when it comes to laparoscopic hysterectomy, according to the findings of a nationwide multivariate 1-year cohort analysis.  However, that rule isn’t hard and fast.

Dutch researchers analyzed 3 outcomes-blood loss, operative time, and adverse events-of approximately 1,500 laparoscopic hysterectomies performed by 79 gynecologic surgeons.

Their results indicate that greater surgical experience is associated with less blood loss and fewer adverse events, and the improvement continues to about 125 procedures-well past the widely held proficiency threshold of 30 procedures.

But a successful outcome does not depend on surgical volume alone, the authors found. Risk factors for unsuccessful outcomes include higher uterus weight, higher body mass index, previous abdominal surgery, type of laparoscopic hysterectomy (ie, supracervical or total is preferable to laparoscopic-assisted vaginal hysterectomy), and 2 surgeons, not 1.

The authors also found a factor of intrinsic surgical skills at work, indicating that skills vary significantly among surgeons and cannot be determined by volume alone. They advise against adopting the common belief that 30 procedures confers proficiency. Instead, they recommend assessing individual ability by comparing individual outcomes for given  procedures on an international scale.

Results were published in Obstetrics and Gynecology (2012;119[4]:700-708).

Read other articles in this issue of Special Delivery