The Learning Curve for Laparoscopically Assisted Vaginal Hysterectomy/Laparoscopic Hysterectomy

Appropriate training and experience necessary for a physician to safely perform laparoscopically assisted vaginal hysterectomy (LAVH) has been a subject of great concern. Reviewed is a 2-year experience of an accomplished endoscopist that includes 88 LAVHs. The learning curve was relatively short with the most rapid operating time and perhaps most difficult procedure encountered within the first 20 cases. After this initial experience, adaptations of basic techniques have been applicable to virtually all subsequent cases encountered. Complications were minor with a rate of 19.76%. One conversion to abdominal hysterectomy was necessary (1.15% conversion rate). The average operating time was 121 minutes with the uterine weight ranged from 60 to 740 g. Average hospital stay was 1.86 days with an average recovery time of 12.65 days. In establishing proficiency in performing LAVHs, it is the author's experience that 20 LAVH's are necessary to encounter a wide enough variation in pelvic pathology to mandate a modification of the basic surgical techniques. Thus, in establishing proficiency, it should be considered that the first 20 cases be performed under the supervision of an experienced endoscopic surgeon.