Page 9 - Journal of World Association of Laparoscopic Surgeons
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Follow-up Study Comparing Open Hysterectomy of Expert Surgeon and Laparoscopic Approach (Learning Curve)
Medical disease, mean age, and preoperative hemoglobin Operation Time
level were not significantly different in patients under 2 groups of In the present study, the surgical time of the two groups had
laparotomy and laparoscopy (Table 1). significant difference (277 minutes in laparoscopy vs 196 minutes in
There was no significant difference regarding intra- and laparotomy). In some studies, laparoscopic and open hysterectomy
postoperative transfusion, hospital stay duration, postoperative were compared, and the learning curve was investigated in a
complications, and readmission in laparoscopy and laparotomy prospective study and there was no difference in complications.
7,19,20
groups of hysterectomy. However, the operative time was In a study, the operating time of laparoscopic history was 104 ± 26
significantly different in laparoscopy and laparotomy subgroups minutes, and after passing the learning curve, it was 72–163 minutes
of hysterectomy, longer in the laparoscopic group (277 minutes in with no significant difference with open surgery. An important
7
laparoscopy vs 196 minutes in laparotomy) (Table 2). point is different reports of early years of laparoscopy with longer
The type of complications during hospital stay and long- procedures in comparison to the open method.
20
term and total complications were not significantly different in Three characters are regarded for learning curve assessment
laparoscopy and laparotomy groups of hysterectomy (p = 0.5). No including the duration of surgery, rate of complications, and the
major complications happened in each of two groups. number of conversions to open surgery. In a study, in the learning
No case of conversion to laparotomy existed in the studied curve of laparoscopic hysterectomy, the first 10 procedures were
laparoscopy cases. done in a mean time of 180 minutes and decreased to 75 minutes
21
in the 90–100th patients.
dIscussIon In the medical center of the present study, the nursing staff,
Transfusion and Blood Loss equipment, and engineering were also in training period (learning
In the present study, transfusion during and after surgery did curve), and the effect of these factors was also evident in the
operative time. For instance, unchecked instruments, camera, and
not differ significantly between the laparoscopy and laparotomy monitoring system exhibited problems during operation which
19
groups. In the other hand, in the present study, just the outcome took time to solve each of them. Of course, whenever the working
of blood transfusion was compared in 2 groups and the volume of system develops, less problems occur during operation, and if
blood loss was not measured. Probably, if it was done, the difference happens, solution is rapidly done.
of blood loss volume might be different in 2 methods. In addition to
the experience of the surgeon, the staffing issues and the surgeon’s Complications
assistant also play a role in the outcome of laparoscopy including In the present study, complications during hospitalization and long-
blood loss. term (after discharge) and total complications of surgery were not
significantly different between the two groups of laparoscopy and
laparotomy. No serious complications occurred in two groups, and
Table 1: Comparison of demographic data, underlying medical disease, the readmission of the two groups did not differ.
and preoperative hemoglobin level in laparoscopic and laparotomy Considering that the surgeon was expert in the open surgery
groups of hysterectomy surgery and radical operations, the complications of her open surgery were
Group less. The point that complications of the open surgery group with
Variables Laparoscopy Laparotomy p a 20-year experience of surgeon and laparoscopic surgery in her
Mean age (SD) 46.37 (6.8) 47.7 (7) 0.318 learning curve did not have a significant difference is in favor of
confirming less complications of laparoscopic surgery.
Medical disease, n (%) 35/54 (64.8) 34/56 (60.7) 0.657
Mean BMI (SD) 28.18 (4.7) 28.59 (5.7) 0.712 Hospital Stay
Mean preoperative Hb (SD) 11.57 (1.76) 11.34 (1.94) 0.516 In a study of laparoscopic and open hysterectomy, the mean
length of the hospital stay was 2.38 ± 0.30 days in the laparoscopic
hysterectomy group vs 6.23 ± 1.85 days in the abdominal
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Table 2: Comparison between laparoscopy and laparotomy groups of hysterectomy group (p ≤ 0.001).
hysterectomy surgery regarding different variables In the present study, the hospital stay was not different in two
groups of laparoscopy and laparotomy. However, patients were not
Group discharged, even if they wanted and were ready to leave hospital,
Variables Laparoscopy Laparotomy p given that the surgeon noted that she was in learning curve and
Intraoperative transfusion, 3/54 (5.6) 5/57 (8.9) 0.999 was willing to closely observe postoperative period of laparoscopy
n (%) patients. In this study, the need for patient pain relief, comfort,
Postoperative transfusion, 8/54 (14.9) 5/57 (8.8) 0.225 satisfaction, and quicker return to work were not considered, which
n (%) might be better in the laparoscopic group.
Mean operative time (SD) 277.44 (84.48) 196.75 (62.13) 0.005
Mean hospital stay (SD) 2.59 (1.22) 2.7 (1.08) 0.211 Readmission
Hospital stay complications 10/54 (18.5) 4/57 (7) 0.68 In the present study, readmission was not different in two groups.
Long-term complications 12/54 (22.2) 7/57 (12.3) 0.51 Conversion Rate
Total postoperative 17/54 (31.5) 9/57 (15.8) 0.51 In a study, readmission rate and complication rate of laparoscopic
complications colorectal surgery were not different in comparison to expert
Rehospitalization, n (%) 1/54 (1.9) 1/57 (1.8) 0.999 surgeons, although decrease in operative time and conversion rate
WorldJournalofLaparoscopicSurgery,Volume12Issue1(January–April2019) 7
