Determining a Learning Curve for Contained Hand Tissue Extraction: Perioperative Outcomes and Operative Time

Abstract

Study objective: To compare the operative time of contained hand tissue extraction with power morcellation and to quantify the learning curve required to develop this skill.

Design: A retrospective cohort study (Canadian Task Force classification II-3).

Setting: Lahey Hospital and Medical Center, a suburban academic tertiary care center serving a broad base of patients.

Patients: Eighty-eight women undergoing laparoscopic hysterectomy requiring morcellation or tissue extraction from 2012 through 2015.

Interventions: Power morcellation before the institution's ban on power morcellation and contained hand tissue extraction instituted in a response to the ban.

Measurements and main results: Data were collected to compare the operative time and perioperative outcomes of morcellation before discontinuation of the power morcellator and after adaptation of a contained hand tissue extraction protocol. The data were then used to determine a learning curve for the new procedure. Eighty-eight consecutive cases of laparoscopic hysterectomy requiring morcellation were identified during the study duration, with 46 patients undergoing power morcellation and 42 undergoing hand tissue extraction. The 2 groups were similar overall in body mass index (28.9 vs 29.5, p = .70), prior laparoscopy (28% vs 21%, p = .46) or laparotomy (39% vs 21%, p = .07), removal of the cervix (56% vs 86%, p < .01), and uterine weight (581 vs 628 g, p = .56). The hand tissue extraction group had an average operating room time of 170 minutes compared with 154 minutes (p = .08) for the power morcellation group. The 2 surgeons performed 32 and 10 hand tissue extractions, respectively, with a decrease in 0.7 and 3 minutes per case, respectively, over the course of 7 months (p = .3 and .6, respectively).

Conclusion: Contained hand tissue extraction was similar to power morcellation in the total operative time. The learning curve of surgeons performing contained hand tissue extraction showed a nonsignificant trend toward improvement in the operative time with an increasing number of cases.

Keywords: Laparoscopic hysterectomy; Morcellation.