Laparoscopic Ovariectomy: A Novices Learning Curve

Objective
To quantitatively assess the learning curve for laparoscopic ovariectomy using the cumulative summation (CUSUM) score technique and moving average operating time.

Study Design
Application of CUSUM technique and moving average operating time to consecutive laparoscopic ovariectomies. Animals: Consecutive laparoscopic ovariectomy in 80 dogs.

Methods
Records of all dogs that had laparoscopic ovariectomy were reviewed. Data retrieved included operative time and intra-operative complications. Operative time was analyzed graphically and complications were analysed with the CUSUM technique.

Results
Eighty laparoscopic ovariectomies were carried out, 79/80 (98.75%) were completed successfully. 1/80 (1.25%) had to convert to an open procedure due to instrument failure. 9/80 (11.25%) of cases had a minor adverse intraoperative event recorded including dropped ovary and minor pedicle bleeding. Mean operative time was 24.85 minutes (+/-10.75). The learning curve was demonstrated to be 34 cases from the CUSUM chart. Mean operating time drops to 20.6 (+/-4.5) minutes once the learning curve has been achieved.

Conclusion
Laparoscopic ovariectomy is a safe technique for the novice laparoscopic surgeon with stabilisation of the learning curve by 34 cases.