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Hum. Reprod. Advance Access published online on January 31, 2008
Human Reproduction, doi:10.1093/humrep/den006
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000–2005

Tea H.I. Brummer1,3, Tomi T. Seppälä2 and Päivi S.M. Härkki1

1 Department of Obstetrics and Gynecology, Helsinki University Central Hospital, PO Box 140, Helsinki, 00029 HUS, Finland 2 Helsinki School of Economics, PO Box 1210, 00101 Helsinki, Finland

3 Correspondence address. E-mail: tea.brummer{at}hus.fi

BACKGROUND: Complications of laparoscopic hysterectomy (LH) have been evaluated with particular focus on quantities of urinary tract injuries. An earlier survey in the 1990s on LH in Finland indicated a decreasing trend in complications; our aim was to evaluate the current complications and hysterectomy trends.

METHODS: All hysterectomies in Finland performed for benign indication from 2000 to 2005 (n = 56 130) were included, data were obtained from the Finnish hospital care register. All major complications reported on LH were analysed; the data were collected retrospectively from the Patient Insurance Centre.

RESULTS: In 2000, the proportion of abdominal hysterectomy (AH) was 38%, vaginal hysterectomy (VH) 37% and LH 25%, whereas in 2005, the proportions were 26%, 45% and 29%, respectively. The overall incidence of major complications in LHs from 1992 to 1999 (LH n = 13 885) was 1.8% and from 2000 to 2005 (LH n = 13 942) it decreased to 1.0%. During the same time, urinary tract injuries decreased from 1.4% to 0.7%; in detail ureteral injuries decreased from 0.9% to 0.3%.

CONCLUSIONS: Laparoscopic and VHs have become more common in Finland than AH. Continuous instruction and training of the Finnish gynaecological surgeons has helped to diminish major complication rates and it seems that in LH, a plateau on the learning curve has been reached.

Key words: hysterectomy/laparoscopic hysterectomy/learning curve/complication/ureteral injuries

Submitted on October 9, 2007; resubmitted on December 27, 2007; accepted on January 8, 2008.


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