Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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Learning curves of total laparoscopic hysterectomies in three gynecologists

세 명의 산부인과 전문의별 복강경하 전자궁절제술의 학습곡선

  • Oh, Yoon-Kyung (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine) ;
  • Hwang, Hyo-Soon (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine) ;
  • Yi, Kyung-Wook (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine) ;
  • Song, Seung-Hun (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine) ;
  • Lee, Jae-Kwan (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine) ;
  • Hur, Jun-Young (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine) ;
  • Shin, Jung-Ho (Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine)
  • 오윤경 (고려대학교 의과대학 구로병원 산부인과) ;
  • 황효순 (고려대학교 의과대학 구로병원 산부인과) ;
  • 이경욱 (고려대학교 의과대학 구로병원 산부인과) ;
  • 송승훈 (고려대학교 의과대학 구로병원 산부인과) ;
  • 이재관 (고려대학교 의과대학 구로병원 산부인과) ;
  • 허준용 (고려대학교 의과대학 구로병원 산부인과) ;
  • 신정호 (고려대학교 의과대학 구로병원 산부인과)
  • Received : 2010.05.11
  • Accepted : 2010.07.12
  • Published : 2010.10.15
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Abstract

Objective: Total laparoscopic hysterectomy (TLH) is becoming more commonly used as an alternative to traditional abdominal hysterectomy and Analyzing the turning point of a learning curve can be useful in planning training programs. This study was to define the average turning point of a learning curve of TLH by comparing three separate gynecologists in one institute. Methods: Retrospective analysis of the first 140 consecutive cases of TLH performed by three separate gynecologists A, B, and C. Patients of each gynecologist were divided into 7 equal groups of 20 operations classed chronologically. Patient's age, uterus weight, operation time and pre-post operative hemoglobin difference of the three gynecologists were compared. Operation time and pre-post operative hemoglobin difference were evaluated to build learning curves for each gynecologist. Results: Learning curve built by operation time showed turning point after 80~100 cases in all three gynecologists. Learning curve built by pre-post operative hemoglobin difference did not show a decreasing pattern. There were no statistical differences in patient's age and pre-post operative hemoglobin difference between the three gynecologists. However, mean uterine weight of gynecologist C was significantly lighter than that of gynecologist A and B. Operation time was significantly longer in cases by gynecologist C than in cases by A and B. Conclusion: At least 80~100 cases of experience in TLH is needed for a gynecologist to reach the turning point of the learning curve. This result can be used as a guide to the training program of TLH.

목적: 복강경하 전자궁절제술은 전통적인 개복하 전자궁절제술의 대체 방법으로 점차 많이 시행되고 있으며 학습곡선의 변환점을 찾는 것은 훈련 과정을 계획하는 데 도움을 줄 수 있다. 이번 연구에서는 동일 기관에서 세 명의 다른 산부인과 전문의의 복강경하 전자궁절제술의 학습곡선을 비교하여 평균 변환점을 찾아보았다. 연구 방법: A, B, C 세 명의 산부인과 전문의에게 수술받은 첫 140명의 환자에 대해 후향적으로 분석하였다. 각 집도의에게 수술받은 환자들은 수술받은 순서대로 20명씩 7개의 그룹으로 나뉘어졌다. 각 집도의 간에 수술받은 환자의 나이, 자궁 무게, 수술 시간, 수술 전후의 혈색소치 변화를 비교하였다. 각 집도의별로 수술 시간과 수술 전후 혈색소치 변화를 이용하여 학습곡선을 구하였다. 결과: 수술 시간으로 그린 학습곡선은 세 집도의 모두에서 80~100건에서 변환점을 보였다. 수술 전후 혈색소치 변화로 그린 학습곡선은 경험에 따라 감소하는 경향을 보이지 않았다. 세 집도의에게 수술받은 환자의 나이와 수술 전후 혈색소치 변화에는 차이가 없었다. 하지만 평균 자궁 무게는 C 집도의에게 수술받은 경우가 나머지 집도의에게 수술받은 경우보다 유의하게 가벼웠고 평균 수술 시간은 C 집도의에서 유의하게 길었다. 결론: 산부인과 전문의가 복강경하 전자궁절제술 학습곡선의 변환점에 다다르기 위해서는 적어도 80~100건의 수술 경험을 필요로 한다. 이러한 결과는 향후 복강경하 전자궁절제술의 훈련 과정에 길잡이로 활용할 수 있겠다.

Keywords

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