Learning curve In Laparoscopic radical hysterectomy - is it really steep? A single institution experience

Volume : VII, Issue : VII, July - 2018

Dr. Subbiah Shanmugam, Dr. Gopu Govindasamy, Dr. Syed Afroze Hussain, Dr. Gurumoorthy Narayanasamy

Introduction: Radical hysterectomy with pelvic lymphadenectomy is the current gold standard treatment for early–stage cervical cancer. Total

laparoscopic radical hysterectomy has been proven to be safe and feasible. But there are only a few literatures available on the learning curve for

this procedure. We have reviewed literature, analysed and discussed the surgical & oncological safety, advantages and short term outcome of

laparoscopic radical hysterectomy.

Objective: Aim of our study is to analyse our learning curve in total laparoscopic radical hysterectomy and to assess the surgical & oncological

safety, advantages and short term outcome of laparoscopic radical hysterectomy

Materials And Methods: This is a retrospective study where medical records of patients who underwent laparoscopic radical hysterectomy at our

department between 2015 and 2016 were reviewed retrospectively. Forty four patients included in the study were divided into the first 22 cases

(phase I) and the second 22 cases (phase II). Disease and surgery related parameters were compared.

Results: There was a significant decrease in the mean operating time, conversion rate, complication rate, duration of hospital stay and time to

normal residual urine in the phase II of learning curve. Operating time and blood loss were significantly less for patients who underwent upfront

surgery than who received preoperative therapy

Conclusion: Although TLRH is a technically demanding procedure with steep learning curve, our early results are promising and comparable with

series in literature. Extensive experience in open radical hysterectomy and familiarity in pelvic anatomy have made our learning curve less steep,

making the procedure be performed with more ease and with less complications after the initial few surgeries. With increasing experience and

appropriate patient selection, TLRH can be safely performed without compromising the oncological safety with all the advantages of minimal

access surgery