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

Francisco Carmona, Angeles Martínez-Zamora, Ángeles Martínez-Zamora, Martínez-Zamora A, Xavier González-Argenté, González X, Xavier González, Angeles Ginés, Àngels Ginès, Laura Buñesch, Buñesch L, Juan Balasch, Balasch J
Fertility and sterility · 2008 · vol. 92(3) , pp. 868–875 · doi:10.1016/j.fertnstert.2008.07.1738 · PMID:18829016 · W2083781680
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This paper investigated whether the learning curve for conservative laparoscopic surgery in women with rectovaginal endometriosis affects the rate of recurrence.

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Abstract

ObjectiveTo 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.DesignProspective cohort study.SettingUniversity 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.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Clinical Competence Endometriosis Gynecologic Surgical Procedures Laparoscopy Adult Cohort Studies Endometriosis Endometriosis Female Gynecologic Surgical Procedures Humans Laparoscopy Length of Stay Length of Stay Postoperative Hemorrhage Postoperative Hemorrhage Prospective Studies Rectum Rectum Retrospective Studies

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