Objective: To estimate, after correction for patient factors, to what extent blood loss, operative time, and adverse events are decisive factors for the successful outcome of laparoscopic hysterectomy. A secondary objective was to estimate to what extent a successful outcome can be predicted from surgical experience or other measures of surgical skill.
Methods: A nationwide multivariate 1-year cohort analysis was conducted with gynecologists who perform laparoscopic hysterectomy. The primary outcomes were blood loss, operative time, and adverse events. The procedures were corrected for multiple covariates in a mixed-effects logistic regression model. Furthermore, all primary outcomes were related to experience and the influence of individual surgical skills factors.
Results: One thousand five hundred thirty-four laparoscopic hysterectomies were analyzed for 79 surgeons. The success of the surgical outcome was significantly influenced by uterus weight, body mass index, American Society of Anesthesiologists Physical Status Classification, previous abdominal surgeries, and the type of laparoscopic hysterectomy. Surgical experience also predicted the successful outcome of laparoscopic hysterectomy with respect to blood loss and adverse events (P=.048 and .036, respectively). A significant improvement in surgical outcomes tends to continue up to approximately 125 procedures. Independently from surgical experience, an individual surgical skills factor was identified as odds ratio 1.67 and 3.60 for blood loss and operative time, respectively.
Conclusion: After adjusting for risk factors, it was shown that an increase in experience positively predicted a successful outcome in laparoscopic hysterectomy with respect to blood loss and adverse events. However, the independent surgical skills factor shows a large variation in proficiency between individuals. The fact that a surgeon has performed many laparoscopic hysterectomies does not necessarily guarantee good surgical outcome.
Level Of Evidence: II.
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http://dx.doi.org/10.1097/AOG.0b013e31824b1966 | DOI Listing |
Taiwan J Obstet Gynecol
January 2025
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan.
Objective: The laparoscopic approach to cervical cancer (LACC) trial highlighted the necessity of an open approach for radical hysterectomy due to its negative impact on oncological outcomes. While minimally invasive surgery is an option for other organ cancers, its application in cervical cancer remains a challenge for surgeons. In this study, we aimed to assess the oncological outcomes of patients with early-stage cervical cancer who underwent minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology at a single institution.
View Article and Find Full Text PDFMedicina (Kaunas)
December 2024
Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
: The objective of this study was to assess the efficient use of advanced energy devices by examining the impact of their usage frequency on surgical outcomes of total laparoscopic hysterectomies. : A retrospective study was conducted between 2020 and 2023 by a single surgeon. The patients' medical records and surgical videos were reviewed.
View Article and Find Full Text PDFDiagnostics (Basel)
December 2024
Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
Background/objectives: This systematic review aimed to evaluate the outcomes of minimally invasive techniques in gynecological cancer surgery, specifically laparoscopic hysterectomies (LHs), robotic-assisted hysterectomies (RHs), and laparoscopic-assisted vaginal hysterectomies (LAVHs).
Methods: We conducted a comprehensive search of electronic databases including PubMed and MedLine from January 2010 to August 2024. The search included randomized controlled trials (RCTs) and observational studies.
Afr J Reprod Health
December 2024
Department of Gynecology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, China.
This was an original research. The objective of the study was to investigate the efficacy of laparoscopic type C radical hysterectomy by deep uterine vein approach in treating cervical cancer. Two hundred cases of cervical cancer were allocated into control group and intervention group.
View Article and Find Full Text PDFCureus
December 2024
Department of Obstetrics and Gynecology, Kastamonu Training and Research Hospital, Kastamonu, TUR.
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