Laparoscopic treatment of ectopic pregnancy. Residents' learning experience

Although operative laparoscopy is a safe and effective method of treating ectopic pregnancy, its widespread acceptance requires appropriate operator training and experience. This retrospective study correlated operative results with experience of the resident performing surgery. Thirteen postgraduate year 3 and 4 gynecology residents treated 60 ectopic pregnancies by laparoscopy. There were four complications: two cases of atelectasis and two of persistent human chorionic gonadotropin titers. There were no blood transfusions. We found that the duration of surgery decreased as operator experience increased, and residents who had experience with five or more cases required a mean operative time of 74 minutes. We conclude from our results that the minimal amount of supervised training necessary for gynecology residents to safety and expeditiously treat ectopic pregnancy laparoscopically is five cases. Furthermore, the minimal morbidity in this study supports our continued recommendation that each resident have prior training experience of at least 10 laparoscopic sterilizations before attempting his or her first case of ectopic pregnancy.