Page 7 - Journal of World Association of Laparoscopic Surgeons

ORIGINAL ARTICLE
Follow-up Study Comparing Open Hysterectomy of Expert

Surgeon and Laparoscopic Approach (Learning Curve) of the

Same Surgeon

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Maliheh Arab , Rajneesh K Mishra ​,​Jatinder​Sigh​Chowhan ​,​Shahla​N​Ardebili , Behnaz Ghavami ​,​Nasrin​Yousefi
AbstrAct
Introduction: The goal of minimal access surgery is to minimize damage to the patient without impairment of immunity and the effect of
treatment compared to traditional open surgical techniques. Laparoscopic hysterectomy requires more surgical skills and the learning curve
is steep. The goal of this study is to compare hysterectomy in learning curve (including about 50 first surgeries) with open hysterectomy of the
same surgeon, expert in open surgery, for complications, hospital stay duration, transfusion, operative time, and readmission.
Materials and methods: In a prospective cohort study, patients undergoing hysterectomy at an academic medical center located in Tehran were
randomly assigned into laparoscopic (in learning curve) and laparotomy groups from 2016 to 2018. Study cases data were recorded regarding
complications, hospital stay, operative time, and blood transfusion.
Results: There was no significant difference regarding intra- and postoperative transfusion, hospital stay duration, postoperative complications,
and readmission in laparoscopy and laparotomy groups of hysterectomy. However, operative time was significantly different in laparoscopy
and laparotomy subgroups of hysterectomy and longer in the laparoscopic group (277 minutes in laparoscopy vs 196 minutes in laparotomy).
Conclusion: This study encourages starting laparoscopy method instead of open surgery, even in the setting of expert open surgeons, and
even in the advanced (level 4) surgery such as hysterectomy.
Keywords: Complications, Hysterectomy, Laparoscopy, Laparotomy, Learning curve.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1359

IntroductIon
The goal of minimal access surgery is to minimize damage to the 1 Department of Minimal Access Surgery, Cancer Research Center,
patient without impairment of immunity and the effect of treatment Shahid Beheshti University of Medical Sciences, Tehran, Iran
compared to traditional open surgical techniques. If this goal is 2 Department of Minimal Access Surgery, The Global Open University,
achieved, patients will recover faster, and hospitalization will be Dimapur, Nagaland, India
reduced, and their return to full activity and work will be returned 3 Department of Minimal Access Surgery, World Laparoscopy Hospital,
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in a short time. The history of laparoscopy is still short and still no Gurugram, Haryana, India
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long-term results in comparison to open surgery are in our hands. 4,6 Department of Obstetrics and Gynaecology, Shahid Beheshti
Today there is a lot of evidence of laparoscopic preference, and University of Medical Sciences, Tehran, Iran
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they all accept it. In general, laparoscopic complications are less 5 Department of Minimal Access Surgery, Tehran University of Medical
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than open surgery. Sciences, Tehran, Iran
In 1999, laparoscopic hysterectomy was considered an alternative Corresponding Author: Maliheh Arab, Department of Minimal
for open surgery. The first laparoscopy was reported in 1989, and then, Access Surgery, Cancer Research Center, Shahid Beheshti University
this method continued. In the case of laparoscopic hysterectomy, of Medical Sciences, Tehran, Iran, Phone: +91 9811416838, e-mail:
compared with open surgery, the surgical time is significantly drmarab@yahoo.com
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longer. In a study, the time of postoperative recovery and the How to cite this article: Arab M, Mishra RK, Chowhan JS, et al. Follow-
pain score in 37 patients with primary pelvic pain with diagnosis of up Study Comparing Open Hysterectomy of Expert Surgeon and
fibroma, adenomyosis, and severe endometriosis who underwent Laparoscopic Approach (Learning Curve) of the Same Surgeon. World
laparoscopic assisted vaginal hysterectomy (LAVH) were recorded. J Lap Surg 2019;12(1):5–8.

The length of hospitalization was 4.5 and 2.5 days after open Source of support: Nil

hysterectomy and LAVH, respectively. LAVH is more expensive than Conflict of interest: None
total abdominal hysterectomy (TAH). The issue is whether the benefits
of shorter recovery and faster return to work, shorter hospitalization,
and less need for pain relief cover the extra cost of laparoscopy. If include reduced postoperative pain, shorter hospitalization, faster
the total healthcare costs are evaluated, the short-term recovery of recovery, and faster social recovery. Laparoscopic hysterectomy is
laparoscopy, 2 weeks, compared to the recovery of 6–8 weeks after longer in all studies.
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open surgery, makes it costly. LAVH can replace most abdominal
hysterectomies due to benign disease. Laparoscopic hysterectomy Training in Laparoscopy
requires more surgical skills, and the learning curve is steep. Studies Besides the great interest in laparoscopy, the cost of training
have shown that laparoscopic advantages comparing to laparotomy and instruments increase the total cost. On the other hand, less
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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