Learning curve for laparoscopic sacrocolpopexy within a structured learning programme.

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A laparoscopic sarcocolpopexy is an operation to treat recurrent vault prolpase in women with pelvic organ prolapse. It is a technically difficult operation to perform and is reported to have a long learning curve. (Claerhout F, Roovers JP, Lewi P, Verguts J, De Ridder D, Deprest J (2009) Implementation of laparoscopic sacrocolpopexy—a single centre’s experience. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1119–1125.) We designed a prospective study aimed at mapping the learning curve of laparoscopic sacrocolpopexy in the setting of a structured learning programme for a urogynaecology fellow at the Royal Brisbane and Women’s Hospital (RBWH). The fellow had basic laparoscopic skills at the commencement of her fellow position and was required to assist in twenty laparoscopic sacrocolpopexies, video-edit two procedures and undertake laparoscopic suturing and knot tying training on a laparoscopic trainer for two hours per week for four weeks. After the completion of this structured learning programme, the fellow will begin performing LSC as the primary surgeon. A group of four experts involved in the training and teaching of LSC agreed that an adequate level of skill would be attained after performance of five consecutive laparoscopic sacrocolpopexies without intra-operative complications (visceral injury, conversion to laparotomy or vaginal surgery, estimated blood loss over 500mls) or Clavien-Dindo grade III-IV post-operative complications and with an operative time of under 90 minutes. Time taken to perform the operation was measured from peritoneal incision trocar placement until the peritoneum was closed over the mesh.

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