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Identifying the Rate-Limiting Step in Total Laparoscopic Hysterectomy in a Training Hospital.

Abstract：

STUDY OBJECTIVE:To identify the lengthiest step of total laparoscopic hysterectomy (TLH) in a teaching hospital and to determine which clinical factors affect the duration of this step. SETTING:The University of Louisville Hospital. DESIGN:Single institution retrospective case series. METHODS AND MAIN RESULTS:This is a retrospective chart and video review that included 135 benign, elective TLHs performed at The University of Louisville. TLH was divided into 5 steps: (1) insertion of laparoscopic ports and adhesiolysis to restore normal anatomy; (2) identification of the ureter and resection of adnexal structures to transection of the round ligament; (3) transection of the round ligament to transection of the uterine artery; (4) lateralization of the uterine vessel pedicle to completion of colpotomy; and (5) completion of vaginal cuff closure. The random intercept and slope model was used to identify the lengthiest step of TLH, and the backward elimination procedure was used to evaluate which clinical factors affected this step. Mean ± SD total length of TLH was 81 ± 30 min. The lengthiest step was colpotomy, with a mean duration of 24 ± 13 min. Uterine weight significantly increased the length of time required for colpotomy (p = .001). The primary energy source (ultrasonic scalpel vs monopolar hook) used to perform colpotomy did not influence the length of time (p = .539 vs p = .583). Uterine weight (p < .001) and adhesiolysis (p = .003) significantly increased the total time of TLH. CONCLUSIONS:At a teaching institution where surgeries are performed by residents and fellows, colpotomy is the lengthiest step of TLH and is influenced by uterine weight. This finding may reflect the training levels of the surgeons performing these cases and the learning curve associated with a challenging surgical skill. Further research should focus on simulation models and/or tools for colpotomy that may result in greater efficiency in the operating room.

journal_name

J Minim Invasive Gynecol

journal_title

Journal of minimally invasive gynecology

authors

Torres D,Lang TG,Pasic R,Biscette S,Gunaratnam B,Shiber LD

doi

10.1016/j.jmig.2015.04.020

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

974-9

issue

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(15)00330-1

journal_volume

pub_type

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Identifying the Rate-Limiting Step in Total Laparoscopic Hysterectomy in a Training Hospital.