Minimally Invasive Specialists and Rates of Laparoscopic Hysterectomy
نویسندگان
چکیده
BACKGROUND AND OBJECTIVE Despite the prevalence of hysterectomy for treatment of benign gynecologic conditions, providers nationwide have been slow to adopt minimally-invasive surgical techniques. Our objective is to investigate the impact of a department for minimally invasive gynecologic surgery (MIGS) on the rate of laparoscopic hysterectomy at an academic community hospital without robotic technology. METHODS This retrospective observational study included all patients who underwent hysterectomy for benign indications from January 1, 2004, through December 31, 2012. The primary outcome was route of hysterectomy: open, laparoscopic, or vaginal. Secondary outcomes of interest included length of stay and factors associated with an open procedure. RESULTS In 2004, only 24 (8%) of the 292 hysterectomies performed for benign conditions at Newton-Wellesley Hospital (NWH) were laparoscopic. The rate increased to more than 50% (189/365) by 2008, and, in 2012, 72% (316/439) of hysterectomies were performed via a traditional laparoscopic approach. By 2012, more than 93% (411/439) of all hysterectomies were performed in a minimally invasive manner (including total laparoscopic hysterectomy [TLH], laparoscopic supracervical hysterectomy [LSH], total vaginal hysterectomy [TVH], and laparoscopy-assisted vaginal hysterectomy [LAVH]). More than 85% of the hysterectomies at NWH in 2012 were outpatient procedures. By this time, the surgeon's preference or lack of expertise was rarely cited as a factor leading to open hysterectomy. CONCLUSIONS A large diverse gynecologic surgery department transformed surgical practice from primarily open hysterectomy to a majority (>72%) performed via the traditional laparoscopic route and a large majority (>93%) performed in a minimally invasive manner in less than 8 years, without the use of robotic technology. This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists.
منابع مشابه
Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective Cross-Sectional Database Review
Background: Minimally invasive hysterectomy is generally preferable to abdominal hysterectomy. The technicity index (TI) is the proportion of hysterectomies performed by minimally invasive surgery. Many centers globally have started to audit local TI as a quality indicator, but only a handful have published their results to help define international standards of care. <st...
متن کاملMinimally Invasive Hysterectomy at a University Teaching Hospital
BACKGROUND AND OBJECTIVES To evaluate the feasibility of a minimally invasive approach for hysterectomy for benign disease at a university teaching hospital. METHODS Five hundred thirty-seven consecutive patients underwent hysterectomy for benign disease at Penn State Milton S. Hershey Medical Center in 2010. No cases were excluded. Minimally invasive approaches included total vaginal hystere...
متن کاملPerceived Proficiency in Minimally Invasive Surgery Among Senior Ob/Gyn Residents
BACKGROUND AND OBJECTIVES To assess self-perceived proficiency in minimally invasive surgical procedures among fourth-year Ob/Gyn residents in the United States and to evaluate trends in self-perceived proficiencies by comparing the current survey to a similar survey distributed in 2001. METHODS A Web-based survey was sent out to all fourth-year residents in accredited obstetrics and gynecolo...
متن کاملInfection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy
BACKGROUND Surgical site infection (SSI) is a common complication of hysterectomy. Minimally invasive hysterectomy has lower infection rates than abdominal hysterectomy. The lower SSI rates reflect the role and benefit in infection control of having minimal incisions, rather than a large anterior abdominal wall incision. Despite the lower rates, SSI after laparoscopic hysterectomy is not uncomm...
متن کاملSafe Laparoscopic Removal of a 3200 Gram Fibroid Uterus
BACKGROUND AND OBJECTIVES Hysterectomy using minimally invasive techniques yields fewer complications, less blood loss, and quicker recovery time compared with traditional abdominal hysterectomy. Despite these advantages, 65% of all hysterectomies in the United States are still performed using traditional laparotomy, and many clinicians still exclude patients with a history of prior abdominal s...
متن کامل