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JAMA. 1993 Dec 8;270(22):2689-92.

Predictors of laparoscopic complications after formal training in laparoscopic surgery.

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Department of Urology, University of Iowa Hospitals and Clinics, Iowa City.



To evaluate the relationship between laparoscopic complication rates and surgeon-dependent variables following a laparoscopic training course.


Participants were surveyed regarding their interval laparoscopic experience 3 months and 12 months after the course.


Course participants/survey respondents represented a cross section of urologic surgeons in the United States. A total of 181 individuals (61% of 297 participants) completed and returned the 3-month questionnaire. A total of 128 surgeons responded to the 12-month questionnaire (78.5% of 163 participants).


Logistic regression analysis tested the relationship between surgeons' complication rates and study variables.


At 3 months, surgeons who performed clinical procedures without additional training were 3.39 times more likely to have at least one complication compared with surgeons who sought additional training (P = .03). At 12 months, surgeons who had attended the training course alone, were in solo practice, or performed laparoscopic surgery with a variable assistant were 4.85, 7.74, and 4.80 times more likely, respectively, to have had a complication than their counterparts who attended the course with a partner, were in group practice, or operated with the same assistant (P = .004, P = .0008, and P = .0015, respectively). At both 3 and 12 months, laparoscopic complication rates of individual surgeons demonstrated a significant inverse correlation with the number of laparoscopic procedures performed.


The rate of complications associated with the clinical learning curve can be decreased by additional education following an initial course in laparoscopy. An ongoing clinical association with surgeons performing similar procedures decreases long-term complication rates.

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