Does the learning curve of conservative laparoscopic surgery in women with rectovaginal endometriosis impair the recurrence rate?

• Published in: Fertility and sterility Vol. 92; no. 3; pp. 868 - 875
• Main Authors: Carmona, Francisco, Ph.D, Martínez-Zamora, Angeles, M.D, González, Xavier, Ph.D, Ginés, Angeles, Ph.D, Buñesch, Laura, M.D, Balasch, Juan, Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2009; Elsevier
• Subjects: Adult; Biological and medical sciences; Clinical Competence; Cohort Studies; Endometriosis; Endometriosis - prevention & control; Endometriosis - surgery; Female; Female genital diseases; Gynecologic Surgical Procedures - adverse effects; Gynecology. Andrology. Obstetrics; Humans; Internal Medicine; laparoscopic surgery; Laparoscopy - adverse effects; learning curve; Length of Stay - statistics & numerical data; Medical sciences; Non tumoral diseases; Obstetrics and Gynecology; Postoperative Hemorrhage - etiology; Prospective Studies; rectovaginal endometriosis; Rectum - surgery; recurrence rate; Retrospective Studies; Secondary Prevention; Time Factors; Treatment Outcome; Vagina - surgery; Endometriosis; recurrence rate; rectovaginal endometriosis; laparoscopic surgery; learning curve; Human; Relapse; Gynecology; Laparoscopic surgery; Obstetrics; Rectovaginal; Female genital diseases; Learning; Conservative surgery; Treatment; Uterine diseases; Female; Woman
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2008.07.1738

Objective To assess the effect of surgeon's increasing experience in conservative laparoscopic surgery of women with rectovaginal endometriosis on the surgical outcome of these patients recurrence rate. Design Prospective cohort study. Setting University teaching hospital. Patient(s) The first 60 consecutive patients undergoing laparoscopic conservative surgery for symptomatic rectovaginal endometriosis at our institution during a 4- year period. Intervention(s) Cases were classified into two groups according to the date of the patient's operation: the first 30 cases were defined as the early cases and the subsequent 30 cases as the late cases. Main Outcome Measure(s) Operating time, perioperative complications, and surgical outcome. Univariate and multivariate analyses for risk factors with recurrence of disease. Result(s) The two groups were similar in patient characteristics. There was a reduction in the rate of laparoconversion, operating time, estimated amount of blood loss, cases with incomplete removal, and recurrence rate with increasing surgeon's experience. Surgical completeness was significantly associated with recurrence of disease. Conclusion(s) A learning curve is demonstrated in the conservative laparoscopic management of patients with rectovaginal endometriosis. After gaining experience in performing 30 cases, the recurrence rate is significantly reduced.