The Survey of Barriers for Vaginal Access Surgery Study.

Study Objective: The primary objective of this study was to describe vaginal hysterectomy practice patterns as well as facilitators and inhibitors to performing vaginal hysterectomy among gynecologic surgeons. Secondary objectives were to describe facilitators and inhibitors to the teaching and training of vaginal hysterectomy.

Design: A quantitative analysis of an online survey and qualitative analyses of the one-on-one interviews with gynecologic surgeons were conducted. This study was approved by the institutional review board.

Setting: Online survey and one-on-one virtual interviews.

Patients: Members of the American Association of Gynecologic Laparoscopists and the Society of Gynecologic Surgeons.

Interventions: None.

Measurements And Main Results: A total of 505 gynecologic surgeons completed the survey. Most surgeons were white (66.9%) and had a clinic in North America (67.5%). Approximately 48% of respondents reported "no barrier" to performing vaginal hysterectomies including pathology, visualization and exposure, and performance of concomitant procedures. Higher surgical volume was the only factor most commonly rated by surgeons as enabling the teaching of vaginal hysterectomy "quite a bit" (31.3%). Most surgeons agreed that vaginal hysterectomies are important to women's health (82.8%) and that all gynecologic surgeons should be able to perform vaginal hysterectomies (66.3%). In terms of medical education and training, most surgeons thought that residents should be required to achieve competency for vaginal hysterectomy before graduation (71.7%) and disagreed (56.0%) that we should eliminate residency graduation requirements for vaginal hysterectomy numbers. From the one-on-one interviews, major themes identified included advocacy, centralizing efforts, compensation and incentives, cycle of low experience, decreasing regional trends, lack of industry support, transvaginal vs laparoscopy culture, varied training targets and resources, innovations in training, and self-motivation.

Conclusions: Vaginal hysterectomy remains important to our field. Identified barriers and major themes from this study can direct future efforts to increase its adoption.