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Can the Learning Curve of Laparoscopic Sacrocolpopexy Be Reduced by a Structured Training Program?

Mowat, Alex, FRANZCOG*; Maher, Christopher, PhD, CU, FRANZCOG*; Pelecanos, Anita, Bachelor Biostatistics

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 272–276
doi: 10.1097/SPV.0000000000000441
Original Articles

Objective The aim of this study was to establish whether the learning curve for laparoscopic sacral colpopexy (LSC) could be significantly reduced in a structured learning program.

Methods We conducted a prospective study aimed at mapping the learning curve of LSC in the setting of a structured learning program for a urogynecology fellow at the Royal Brisbane and Women's Hospital.

The fellow was laparoscopic suturing and dissection naive at the commencement of her fellow position and was required to assist in 20 LSCs, video-edit 2 procedures, and undertake laparoscopic suturing and knot tying training on a laparoscopic trainer for 2 h/wk during the trial period.

After the completion of this structured learning program, the fellow began performing LSC as the primary surgeon.

Symptomatic assessment of pelvic organ prolapse and pelvic floor dysfunction was undertaken preoperatively and 12 months postoperatively using the Australian Pelvic Floor Questionnaire.

Objective success at 12 months was defined as less than stage 2 prolapse in any compartment. Subjective success was defined as no prolapse on Q 28 to 31 on the Australian Pelvic Floor Questionnaire, and patient-determined success was defined as “much” or “very much better” on the Patient Global Impression of Improvement at 12 months.

Results Five consecutive LSC in 90 minutes or less without intraoperative or postoperative complications was achieved by case 18. Overall objective success at 12 months was 91%, and subjective and patient-determined success was 95%.

Conclusion Previous studies on LSC that report a similar learning curve have recorded much longer operating times. We believe that the shorter operating time, without compromise to outcomes and complication rates, is a result of the structured learning program.

The learning curve of laparoscopic sacrocolpopexy can be shortened by a structured training program.

From the *Royal Brisbane and Women's Hospital and University of Queensland and

Queensland Institute of Medical Research, Queensland, Australia.

Correspondence: Alex Mowat, FRANZCOG, Suite 23 Greenslopes Specialist Centre, Greenslopes 4120, Australia. E-mail: zanhmowat@gmail.com.

The authors have declared they have no conflicts of interest.

This clinical trial registration number is ACTRN12617000130369.

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