Archives of Gynecology and Obstetrics

, Volume 298, Issue 4, pp 763–771 | Cite as

Total laparoscopic hysterectomy: how does training for surgeons in a standardized operation affect hospitals and patients?

  • Thomas HildebrandtEmail author
  • Seher Emir
  • Alexander Boosz
  • Matthias W. Beckmann
  • Andreas Müller
General Gynecology



Surgical training usually means inexperienced physicians initially doing operations supervised by an experienced physician, to gain the experience and skills needed to conduct surgery independently. Various issues arise here for both hospitals and patients. Are training procedures associated with higher complication rates, blood losses, and transfusion rates? What does training in the operating room ultimately cost in terms of valuable surgical time? Do longer hospitalization periods potentially mean financial losses for the hospital under the diagnosis-related groups (DRG) system?


A retrospective analysis was carried out of data for 571 patients who underwent total laparoscopic hysterectomy (TLH) in the Department of Gynecology at the University of Erlangen from 2009 to 2012, with/without adnexectomy, due to benign indication; and of data for 255 patients who underwent the same procedures in Karlsruhe Municipal Hospital in 2013–2014. The patients were classified into two groups: those in whom surgery was carried out by experienced specialists who had carried out at least 40 independent operations; and those in whom it was carried out by a trainee resident who had personally done fewer than 40 operations.


In the two groups, the patients had similar mean body mass indexes, uterus weights, and blood losses. Patients in the specialist group were slightly older. There were no differences in complication rates. Over two-thirds of complications occurred in patients with previous surgery. Procedures by residents took significantly longer. Hospitalization periods in both groups were still below the mean threshold length of stay under Germany’s DRG system, so that no income losses occurred even with training procedures.


Training and teaching operations supervised by experienced surgeons are just as safe as operations by experienced surgeons themselves. Interpretation of these data is of course limited by the retrospective study design; patients treated by specialists tended to have more prior operations and were older, with a trend toward larger uteri. Surgical training, as the example of TLH in benign indication shows here, involves an additional time of approximately 10–20 min per operation. With regard to the revenue situation, the hospitalization periods in both groups were within the profit zone for the hospital concerned.


Hysterectomy Training Complication rate Laparoscopy Revenue situation 


Author contributions

TH: data collection or management, data analysis, manuscript, writing/editing. SE: data collection or management. AB: data collection or management. MWB: supervising/proof reading. AM: project development, data analysis, manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the survey involving human participants were in accordance with the ethical standards of institutional and national research committee (Ethic Committee of Friedrich Alexander University of Erlangen-Nuremberg). The study does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsKarlsruhe Municipal HospitalKarlsruheGermany
  2. 2.Department of Gynecology and Obstetrics, Erlangen University HospitalFriedrich Alexander University of Erlangen-NurembergErlangenGermany

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