Learning laparoscopic myomectomy

To describe and to analyse the learning effect in laparoscopic myomectomy. Hospital chart records of 351 patients were retrospectively evaluated. Myomectomy was performed in a standardised fashion. To assess a potential learning effect, only cases presenting a singular intramural fibroid were analysed if a surgeon had done more than ten laparoscopic myomectomies of this type. Cases were analysed according to the order of surgery for the individual surgeon: group A comprised the first ten cases of each surgeon compared with group B, which comprised the subsequent cases. Eighty cases were performed by five surgeons. Group A comprised 50 cases and group B comprised 30 cases. No difference was found with regard to patients' age, BMI, and size of the fibroid. Rate of intra-and postoperative complications according definition were lower in group B but failed to be of statistical significance. Duration of surgery improved after ten cases and no severe complications were noted beyond the tenth case. A learning experience of at least ten laparoscopic myomectomies was necessary in our institution to improve duration of surgery and to reach a low level of severe complications. Duration of the surgical procedure and rate of severe complication were adequate study end points to assess a learning effect.