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- Title
Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy.
- Authors
Marret, H.; Chevillot, M.; Giraudeau, B.; Study Group of the French Society of Gynaecology and Obstetrics (Ouest Division)
- Abstract
<bold>Background: </bold>To assess the probability of conversion of a laparoscopic myomectomy to an open procedure, we only found the score developed by Dubuisson et al. (2001) based on four preoperative risk factors. Routinely this score is not appropriate, as realized by the most skilled laparoscopic surgeons.<bold>Methods: </bold>The aim of this study was to identify the preoperative factors affecting the risk of conversion in data collected in different centers among a population of surgeons at the beginning of their experience in laparoscopic myomectomy. We collected preoperative clinical and ultrasonography data for all laparoscopic myomectomies performed in 11 hospital centers between January 1996 and December 2000. Data were available for 116 patients. Multiple logistic regression was use to develop a simple predictive model based on available preoperative risk factors of laparoconversion.<bold>Results: </bold>We encountered 33 laparoconversions (28%) compared to an expected number of 7.8 using Dubuisson's score. We confirmed the importance of two of the four risk factors in Dubuisson's model: biggest myoma size at ultrasonography (increased 1 mm) (OR: 1.06) and intramural type (OR: 3.25) of the dominant myoma. However, we also identified another risk factors: surgeon's experience (OR: 0.15). Simple score was calculated and used to provide an estimated risk of conversion.<bold>Conclusion: </bold>Our model is a useful tool to predict laparoconversion for surgeons beginning in laparoscopic myomectomy. Ultrasound evaluation is essential before performing the procedure. Skilled surgeons in laparoscopy and in laparoscopic myomectomy must help their trainees during their learning curve in order to reduce laparoconversion rate.
- Subjects
MYOMECTOMY; SMOOTH muscle surgery; UTERINE surgery; UTERINE fibroid treatment; LAPAROSCOPIC surgery; LAPAROSCOPY; MYOMETRIUM surgery; ULTRASONIC imaging; UTERINE tumors; MATHEMATICAL models; UTERINE fibroids; REGRESSION analysis; RETROSPECTIVE studies; ABDOMINAL surgery; FORECASTING; THEORY; JOB performance
- Publication
Acta Obstetricia et Gynecologica Scandinavica, 2006, Vol 85, Issue 3, p324
- ISSN
0001-6349
- Publication type
journal article
- DOI
10.1080/00016340500438165