Who is "experienced"?

I was intrigued by the article in the January issue of OB.GYN. NEWS entitled "Longer OR Times Confirmed in Robotic Hysterectomy" (p. 11), referencing the paper presented by Dr. Marie Fidela Paraiso at the recent AAGL meeting. As I commented to Dr. Paraiso at the time of the meeting, I have serious concerns about the validity of this study, based on the researchers' definition of "experienced" robotic surgeons as surgeons who had performed at least 10 robotic hysterectomies.

Numerous studies, most notably those by Dr. John Lenihan, demonstrate that "in the hands of surgeons with advanced laparoscopic skills, the learning curve to stabilize operative times for the various surgical procedures in women requiring benign gynecologic [robotic] interventions is 50 cases" (J. Minim. Invasive Gynecol. 2008; 15:589-94).

Editors' note: We could not reach Dr. Paraiso for comment.

Larry R. Glazerman, M.D. Director, Minimally Invasive Gynecologic Surgery University of South Florida, Tampa