Early surgical practice in obstetrics and gynecology specialization: Insights from the first 18 months.

Abstract

This study aims to assess the surgical practices, learning curve, and outcomes of 2 obstetrics and gynecology specialists during the first 18 months of their careers, focusing specifically on minimally invasive gynecological procedures. Data from 277 procedures performed by 2 recently specialized gynecologists in Turkey during the first 18 months of their specialization were retrospectively analyzed. Procedures included total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), abdominal hysterectomy (TAH), and other gynecological surgeries. Surgical cases were divided into three 6-month periods, and outcomes such as surgical indications, operative time, length of hospital stay, and complications were evaluated. The study included 277 procedures performed during the first 18 months of a newly specialized obstetrics and gynecology specialist's practice. TLH was the most frequently performed procedure, with 140 cases, followed by VH with 35 cases and total abdominal hysterectomy (TAH) with 22 cases. The study showed a significant reduction in major complications, with only 4 recorded over the 18 months, including bowel injury and bladder injury. Minor complications, such as wound infections and hematuria, were reported in 8 cases (2.9%), and these decreased significantly over time (P = .01). Operation times were shortest in the TLH group (99.6 minutes), and the average hospital stay was shortest for TLH (1.6 days). Overall, 98.6% of surgeries were completed without major complications, with a 100% success rate in the last 6 months. This study highlights the challenges and successes of early surgical practice in gynecology. TLH emerged as the preferred method due to its advantages, while VH was emphasized as the preferred approach when feasible. Regular simulation training, higher case volumes during residency, and mentorship contributed to successful outcomes. These findings underscore the importance of structured training and continuous practice in advancing competency in minimally invasive gynecological surgery.