Learning curve of laparoscopic hysterectomy in a zonal hospital setting: a retrospective analysis of 102 cases operated by a single surgeon


  • Praveen Kumar Department of Obstetrics and Gynecology, ART Centre, Army Hospital (Research and Referral), New Delhi, India
  • Krishan Kapur Department of Obstetrics and Gynecology, Base Hospital, New Delhi, India
  • P. Mohan Bhat Department of Obstetrics and Gynecology, 166 Military Hospital, C/O 56 APO, Jammu, India
  • Nikhil Karkhanis Department of Anaesthesiology, Base hospital, Lucknow, Uttar Pradesh, India




Lap Assisted vaginal hysterectomy, Learning curve, Total lap hysterectomy


Background: The aim of this study was to analyse the learning curve and clinical efficacy of the art of laparoscopic hysterectomy in a zonal hospital setting.

Methods: We conducted a retrospective analysis of 102 women who underwent laparoscopic hysterectomy (LAVH/ TLH) by a single surgeon after post-graduation for benign uterine pathology in a zonal hospital setting. They were divided into two groups of first 50 cases (Group I) and next 52 cases (Group II). The primary outcome was the learning curve of the operating gynaecologist in terms of reduction in duration of surgery, reduced perioperative complications, increasing percentage of TLHs with time.

Results: 102 women underwent laparoscopic hysterectomy for the benign uterine pathology successfully. Surgical outcomes of laparoscopic hysterectomy in terms of mean operative time was 135 mins (Group I) vs 93 mins (Group II), estimated blood loss 255 ml (Group I) vs 140 ml (Group II), hospital stay 05 days (Group I) vs 03 days (Group II), duration of postoperative analgesia 07 days (Group I) vs 05 days (Group II). As the surgical experience increased, patients with bigger uterine size (>10-week size) were taken up for hysterectomy, percentage of TLH increased in Group II as compared to Group I (42.31% vs 18%), with decreasing complications and shorter recovery time.

Conclusions: Laparoscopic hysterectomy (LAVH/ TLH) has a short learning curve and it's a feasible and beneficial surgical modality for treating benign uterine pathology even in a zonal hospital setting (low resource setting).


Bower JK, Schreiner PJ, Sternfeld B, Lewis CE. Black-White Differences in Hysterectomy Prevalence: The CARDIA Study. Am J Public Health. 2009;99(2):300-7.

De Frances CJ, Lucas CA, Buie VC. 2006 National Hospital Discharge Survey. Natl Health Stat Report. 2008;5:1-20.

Johns A. Supracervical versus total hysterectomy. Clin Obstet Gynecol. 1997;40(4):903-13.

Reich H, DeCaprio J, McGlynn F. Laparoscopic hysterectomy. J Gynecol Surg. 1989;5:213-6.

Wu JM, Wechter ME, Geller EJ. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007; 110:1091-5.

Wright JD, Ananth CV, Lewin SN. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013; 309:689-98.

AAGL Position Statement. Route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011;18:1-3.

Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion 444. Obstet Gynecol. 2009;144:1156-8.

Lee J, Jennings K, Borahay MA. Trends in the national distribution of laparoscopic hysterectomies from 2003 to 2010. J Minim Invasive Gynecol. 2014; 21:65-61.

Rosero EB, Kho KA, Joshi GP, Giesecke M, Schaffer JI. Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease. Obstet Gynecol. 2013;122:778-86.

Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol. 2009;144:3-7.

Moen M, Noone M, Cholkeri Singh A, Vassallo B, Locker B, Miller C. Progressive reduction in abdominal hysterectomy rates: Impact of laparoscopy, robotics and surgeon factors. J Robot Surg. 2014; 8(1):13-7.

Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A. Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg. 2016;35:51-7.

Garrett AJ, Nascimento MC, Nicklin JL, Perrin LC, Obermair A. Total laparoscopic hysterectomy: The Brisbane learning curve. ANZJOG. 2007;47:65-9.

Mavrova R, Radosa JC, Wagenpfeil G, Hamza A, Solomayer EF, Boss IJ. Learning curves for laparoscopic hysterectomy after implementation of minimally invasive surgery. Int J Gynaecology and Obstetrics. 2016;134:225-30.

Altgassen C, Michels W, Schneider A. Learning laparoscopic-assisted hysterectomy. Obstet Gynecol.2004; 104(2):308-13.

Makinen J, Johansson J, Tomas C. Morbidity of 10110 hysterectomies by type of approach. Human Reprod. 2001;16(7):1473-8.

Vaisbuch E, Goldchmit C, Agmon A. Lparaoscopic hysterectomy versus total abdominal hysterectomy: a comparative study. Eur J Obstet Gynecol Reprod Biol. 2006;126(2):234-8.

Fabio CM Torricelli, Joao Arthur BA Barbosa, Giovanni S Marchini. Impact of laparoscopic surgery training laboratory on surgeon’s performance. World J Gastrointestinal Surg. 2016;8(11):735-43.

Paek J, Kim SW, Lee SH, Lee M, Yim GW, Nam EJ et al. Learning curve and surgical outcome for single port access total laparoscopic hysterectomy in 100 consecutive cases. Gynaecol Obstet Invest. 2011;72: 227-33.

Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: A meta-analysis. European journal of obstetrics and gynaecology and reproductive biology. 2009;144(1):3-7.

Wattiez A, Soriano D, Cohen SB. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc. 2002;9:339-45.

Ostrzenski A, Radolinski B, Ostrzenska KM. A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv. 2003;58:794-9.

Karaman Y, Bingol B, Gunenc Z. Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol. 2007;14:78-84.

Brummer TH, Seppala TT, Harkki PSM. National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000-2005. J Human Reprod. 2008;23(4):840-5.






Original Research Articles