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Decline in surgeon volume after successful implementation of advanced laparoscopic surgery in gynecology: An undesired side effect? | LitMetric

AI Article Synopsis

  • The study examines trends in advanced minimally invasive surgical (MIS) procedures in the Netherlands, highlighting how hospital and surgeon volumes affect patient outcomes, especially after the implementation of these techniques.
  • Data was collected through a national questionnaire focusing on the volume of laparoscopic and robotic procedures, revealing an overall increase in hospital volumes but a concerning decrease in the number of active gynecologists performing these procedures.
  • Despite an increase in certain procedure volumes, a significant portion of gynecologists are still performing fewer advanced surgeries, indicating a potential risk to patient safety and the need for adjustments in training and resource allocation.

Article Abstract

Introduction: The implementation of advanced minimally invasive surgical (MIS) techniques has broadened. An extensive body of literature shows that high hospital and surgeon volumes lead to better patient outcomes. However, no information is available regarding volume trends in the post-implementation phase of MIS. This study investigated these trends and poses suggestions to adjust these developments. This knowledge can provide guidance to optimize patient safe performance of new surgical techniques.

Material And Methods: A national retrospective cohort study in the Netherlands. The number of advanced laparoscopic (level 3 and 4) and robotic procedures and the number of gynecologists performing them were collected through a web-based questionnaire to determine hospital and gynecological surgeon volume. These volumes were compared with our previously collected data from 2012.

Results: The response rate was 85%. Hospitals produced larger volumes for advanced laparoscopic and robotic procedures. However, still 63% of the hospitals perform low-volume level 4 laparoscopic procedures. Additionally, gynecological surgeon volumes appeared to decrease for level 3 procedures, as the group of gynecologists performing fewer than 20 procedures expanded (64% vs. 44% in 2012), with 15% of the gynecologists performing fewer than ten procedures. Despite an increase in surgeon volumes for level 4 laparoscopy and robotic surgery, volumes continued to be low, as still 49% of gynecologists performed fewer than 10 level 4 procedures per year and 41% performed fewer than 20 robotic procedures per year.

Conclusions: The broad implementation of advanced MIS procedures resulted in an increasing number of these procedures with increasing hospital volumes. However, as a side-effect, a disproportionate rise in number of gynecologists performing these procedures was observed. Therefore, surgeon volumes remain low and even decreased for some procedures. Centralization of complex procedures and training of specialized MIS gynecologists could improve surgeon volumes and therefore consequently enhance patient safety.

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Source
http://dx.doi.org/10.1111/aogs.14242DOI Listing

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