Influence of Surgical Experience in Performing the Abdominal Hysterectomy and Improving the Linear Curve of Skills

Abstract

Objectives: This study aimed to highlight the influence of surgical experience in performing the abdominal hysterectomy and improving the linear curve of skills.

Background: Hysterectomy is the most frequently conducted major gynecological surgical procedure. Several approaches to hysterectomy are available to surgeons. It may be performed by an abdominal incision (total abdominal hysterectomy [TAH]) or by less invasive approaches, including vaginal hysterectomy (VH), total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), or robotic hysterectomy (RH).

Materials and Methods: This retrospective study was conducted on 245 women who underwent hysterectomy at Jordan University Hospital, Amman, Jordan, from January 2017 to 2019. The gravidity, parity, age, body mass index, the cause and type of the hysterectomy, duration of surgery, need for blood transfusion, estimated blood loss, time of hospital stay, intraoperative and postoperative complications, and the histopathology results were extracted from records of the participants and analyzed.

Results: This study showed that the leading cause of hysterectomy in participants was abnormal vaginal bleeding. The most common type of hysterectomy was a simple abdominal hysterectomy with a mean operation time of 1 hour 12 minutes. In total, 25.6% of women received packaged red blood cells, the main cause of which was preoperative anemia (17.5%). These results reflect an improvement in the linear curve of learning surgical skills. Increasing the learning curve in teaching hospitals will help patients and be implemented for benign or malignant situations, particularly with the stability of the medical team. Interestingly, the effect of the acquired skills grew by practice and proved to be preferential over previous years.

Conclusions: Our findings demonstrated how performing abdominal hysterectomy improved surgical technique expressively, resulting in shorter operating times than when using a traditional technique, lower overall surgical costs, and fewer surgical threads needed for each procedure. Numerous clinical metrics, such as mean operative time, complication rates, and other outcome variables, can be used to evaluate surgical expertise. These outcomes were directly caused by the medical team's perseverance and the development of surgical abilities.