ObjectiveThe objectives of this study were to compare laparoscopic assisted vaginal hysterectomies performed in a residency training program, where training is relatively structured and consistent, with laparoscopic assisted vaginal hysterectomies performed in a private institution, where training is largely accomplished through continuing education courses; to compare complications and their rate of occurrence at the two institutions; and to examine data to identify the existence of a “learning curve.”Study DesignA retrospective chart review of 128 patients on whom laparoscopic assisted vaginal hysterectomies were performed between July 1991, and June 1995, was undertaken at two institutions to examine complications and their rate of occurrence. Data, which included patient age, parity, preoperative diagnosis, disease, estimated blood loss, operative time and complications, and surgical technique, were reviewed on all laparoscopic assisted vaginal hysterectomies performed at a university-based training program and a large private community hospital.ResultsPatient demographics at the two institutions were similar. There were 50 minor complications that occurred at institution A and 66 that occurred at institution B. There was little difference in the incidence of the complications, with the exception of postoperative febrile morbidity and urinary tract infections, which occurred at a higher rate. A higher incidence of complications, particularly major complications, occurred at institution B, particularly in patients who underwent a stage 4 or 5 laporascopic assisted vaginal hysterectomy as noted by John's and Diamond's classification.ConclusionsThe training and credentialing of physicians in private practice, where a majority of laporascopic assisted vaginal hysterectomies are performed, has raised concern. Insufficient numbers of are laparoscopic assisted vaginal hysterectomies are performed by most surgeons for them to become proficient and perform the surgery safely. There was also an apparent decrease in complications in patients who underwent laparoscopic assisted vaginal hysterectomies in which the laparoscopic portion was halted at the level of the bladder flap.