Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands

Objective: To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands. Design: Prospective multicenter study (Canadian Task Force II-2). Setting: Ten community (teaching) hospitals in the Netherlands. Patient(s): A total of 631 women who underwent permanent sterilization by tubal microinserts. Intervention(s): Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement. Main Outcome Measure(s): Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications. Result(s): Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience. Conclusion(s): A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience.