The impact of a simulation-based training lab on outcomes of hysterectomy

Objective: To evaluate the impact of a simulation-based training lab on surgical outcomes of different hysterectomy approaches in a resident teaching tertiary care center. Material and Methods: This retrospective cohort study was conducted at The University of Texas, Department of Obstetrics and Gynecology. In total, 1397 patients who had undergone total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), total laparoscopy-assisted hysterectomy (TLH), or robot-assisted hysterectomy (RAH) for benign gynecologic conditions between 2009 and 2014 were included in the study. The comparison was made according to the year when the surgeries were performed: 2009 (before simulation training) and the combination of 2010-2014 (after simulation training) for each technique (TAH, VH, and LAH). Since a simulation lab for robotic surgery was introduced in 2010 at our institute, the comparison for robotic surgery was made between the combination of 2009-2010 as the control and the combination of 2010-2014 as the study group. Results: The average estimated blood loss before and after simulation-based training was significantly different in TAH and RAH groups (317 +/- 170 mL versus 257 +/- 146 mL, p=0.003 and 154 +/- 107 mL versus 102 +/- 88 mL, p=0.004, respectively), but no difference was found for TLH and VH. The mean of length of hospital stay was significantly different before and after simulation-based training for each technique: 3.7 +/- 2.3 versus 2.9 +/- 2.2 days for TAH, 2.0 +/- 1.2 versus 1.3 +/- 0.9 days for VH, 2.4 +/- 1.3 versus 1.9 +/- 2.5 days for TLH, and 2.0 +/- 1.3 versus 1.4 +/- 1.7 days for RAH (p<0.01). Conclusion: Based on our data, simulator-based training may play an integrative role in developing the residents' surgical skills and thus improving the surgical outcomes of hysterectomy.