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Characterizing the Learning Curve for Laparoscopic Radical Hysterectomy: Buddy Operating as a Technique for Accelerating Skill Acquisition
  1. Clare Reade, MD*,
  2. Jan Hauspy, MD,
  3. Mary-Lou Schmuck, BA and
  4. Francois Moens, MD§
  1. *Department of Obstetrics and Gynecology, McMaster University,Hamilton, Canada;
  2. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, St Augustinus Hospital, Antwerp, Belgium; and
  3. Programme for Educational Research and Development and
  4. §Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, McMaster University, Hamilton, Canada.
  1. Address correspondence and reprint requests to Jan Hauspy, MD, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, St Augustinus Hospital, Oosterveldlaan 24, Antwerpen 2610, Belgium. E-mail: Jan.hauspy{at}


Objective: Total laparoscopic radical hysterectomy (TLRH) requires advanced skill in laparoscopy. We evaluated various objective measurements of surgical skill representing the learning curve throughout the first 2 years of implementation of TLRH at our institution. We also describe our technique of "buddy operating," where 2 surgeons combine referrals and operate together, thereby increasing the rate of skill acquisition.

Methods: Charts were retrospectively reviewed for 45 patients undergoing TLRH and pelvic lymphadenectomy at the Hamilton Health Sciences from August 14, 2007, to August 14, 2009. A discriminant function analysis was used to describe the learning curve. χ2 and t tests were used for discrete variables.

Results: The most predictive learning curve model divided the sample in two, with an accurate group assignment 72.1% of the time. After the first 23 procedures, operative time was significantly shorter (201.7 vs 176.6 min, P = 0.02), estimated blood loss was significantly lower (355.7 vs 196.3 mL, P = 0.01), the number of lymph nodes removed was significantly higher (11.5 vs 15.3, P = 0.02), and hospital length of stay was significantly shorter (1.57 vs 0.14 days, P = 0.002). There were nonsignificant trends toward decreasing intraoperative complications and postoperative morbidity.

Conclusions: Total laparoscopic radical hysterectomy with pelvic lymphadenectomy is an important procedure in gynecologic oncology. After a fellowship training program including laparoscopy, we demonstrate the learning curve improves after only 23 cases. This is shorter than previously reported and may be due to "buddy operating," a novel technique for reducing the learning curve in infrequently performed complex procedures.

  • Learning curve
  • Laparoscopic radical hysterectomy
  • Cervical cancer
  • Buddy operating

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  • The authors did not receive financial support for this study.