Editor—Garry et al showed that laparoscopic hysterectomy was associated with a higher rate of major complications than was abdominal hysterectomy.1 Can two techniques be compared, however, when one has been used for 100 years and the other for only a few months?
We found that in a group of surgeons performing laparoscopic surgery for more than 10 years the learning curve for laparoscopic hysterectomy is much greater than 25 cases, particularly when studying infrequent major complications.2,3
Comparing patients operated on between 1989 and 1995 with those operated on between 1996 and 1999, we found that the incidence of conversion to laparotomy decreased from 4.7% (33 cases out of 695) to 1.4% (13 cases out of 952), the incidence of major complications from 5.6% to 1.3%, and the operating time from 115 minutes to 90 minutes. The percentage of laparoscopic hysterectomy among non-vaginal hysterectomies, however, increased from 68% to 94.4%.
Consequently we think that
It was too early to design such a trial
The main conclusion of the study cannot be accepted
The increased complication rate would be valid if the study was repeated today by teams who have been using laparoscopic hysterectomy for more than five years.
As this trial confirmed all the advantages of laparoscopy over laparotomy, and the complication rate decreases significantly when the learning curve has been completed, we conclude that this study is actually the first to show the bright future of laparoscopic hysterectomy.
Competing interests: None declared.
References
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