The Impact of the First Assistant's Experience on the Perioperative Outcome of Patients Undergoing Laparoscopic Hysterectomies for Benign Diseases: A Retrospective Analysis

Objective: This study aims to assess the impact of the experience of an assistant surgeon on the perioperative outcome in laparoscopic gynecological surgeries for benign diseases. Materials and Methods: This was a retrospective review of 572 laparoscopic hysterectomies performed between 2019 and 2024. Data were stratified into two groups based on the experience of the first assistant: Group 1, in which assistant surgeons were experienced (had already assisted in >15 surgeries), and Group 2, in which assistant surgeons were new (had assisted in <15 surgeries). Outcomes were compared between the groups. The primary outcome was the perioperative complication rate, and the secondary outcomes were operative time, estimated blood loss, length of hospital stays, rate of conversion to laparotomy, and rate of reoperation. Results: Among the total cases included, 245 were assisted by an experienced assistant surgeon (Group 1) and 327 by a novice first assistant (Group 2). A statistically significant difference was noted for the baseline characteristics among the groups; diabetes mellitus was higher in Group 2, whereas previous cesarean section and intra-abdominal adhesions were higher in Group 1. Operative time, amount of blood loss, and conversion to laparotomy rate were significantly higher in Group 2. However, after adjusting for the age, body mass index, comorbid conditions, weight of the uterus, and intraoperative adhesions, using inverse probability of treatment weighting, only operating time remained significantly higher in Group 2 (121 min vs. 84 minutes, p -value <0.001). Conclusion: The inclusion of a novice first assistant in laparoscopic hysterectomy did not adversely impact operative outcomes.