Implementing an advanced laparoscopic procedure by monitoring with a visiting surgeon.

STUDY OBJECTIVE To investigate the feasibility of safely implementing a total laparoscopic hysterectomy (LH) in established gynecologists' practices with on-site coaching and monitoring of the learning curve by an experienced visiting surgeon. DESIGN Multicenter prospective feasibility and implementation study (Canadian Task Force classification II-2). SETTING Eleven general gynecologists in 8 hospitals (1 university hospital and 7 regional hospitals) participated. PATIENTS Laparoscopic hysterectomy was performed in 83 patients during the learning curve, and in 83 patients after the learning curve. INTERVENTIONS During the learning curve, an experienced visiting laparoscopist was available for coaching during each LH. A competence score was marked on an Objective Structured Assessment of Technical Skills (OSATS) form. Complications were recorded intraoperatively and postoperatively for 6 weeks after surgery in all patients. MEASUREMENTS AND MAIN RESULTS Nine of 11 gynecologists reached the competence score of at least 28 points during the study, from January 2005 to January 2007. A major complication occurred in 3 of 83 LH procedures (4%) performed during the learning curve, and in 5 of 83 LH procedures (6%) performed after the learning curve (p = .72). CONCLUSION The concept of a visiting surgeon for on-site coaching and monitoring of established gynecologists during the learning curve of an advanced laparoscopic procedure using Objectively Structured Assessment of Technical Skills is feasible. According to the observed complication rate during and after the learning curve, on-site coaching is a useful tool when implementing a new laparoscopic technique in established gynecologists' practices.