Feasibility and safety of a surgical training program in total laparoscopic hysterectomy: Results of a pilot trial

Author:

Obermair Andreas12ORCID,Hanna George B.3,Gebski Val4ORCID,Graves Nicholas5ORCID,Coleman Mark G6ORCID,Sanjida Saira7ORCID,Horsham Caitlin7ORCID,Rao Archana2,Janda Monika7ORCID

Affiliation:

1. Centre for Clinical Research University of Queensland Brisbane Queensland Australia

2. Queensland Centre for Gynaecological Cancer Research Royal Brisbane and Women's Hospital Brisbane Queensland Australia

3. Department of Surgery & Cancer, Faculty of Medicine Imperial College London United Kingdom

4. NHMRC Clinical Trials Centre University of Sydney Sydney New South Wales Australia

5. Health Services & Systems Research Duke National University of Singapore Singapore City Singapore

6. Department of Surgery University Hospitals Plymouth NHS Trust, Derriford Hospital Plymouth United Kingdom

7. Centre for Health Services Research, Faculty of Medicine University of Queensland Brisbane Queensland Australia

Abstract

BackgroundIt is widely accepted total laparoscopic hysterectomy (TLH) and vaginal hysterectomy are less invasive procedures compared to total abdominal hysterectomy (TAH). However, rates of TAH remain unreasonably high.AimTo pilot‐test a model of training for practising obstetricians and gynaecologists (O&Gs) in TLH.Materials and MethodsTraining of participating O&Gs was conducted across four hospitals in Queensland, Australia, while other O&Gs were observed as contemporary controls. Type of hysterectomy, details of the surgery, including adverse events, were collected from hospital medical records.ResultsEleven O&Gs completed the pre‐intervention and intervention training periods, and nine completed the post‐intervention follow‐up. TLH rates increased from 24% prior to 75% during and 68% after intervention. Overall, the uptake rate of TLH showed a two‐fold increase during the intervention period (2.08, 95% CI: 1.16–8.56, P < 0.001) and a 12% increase was retained during the follow‐up period (1.12, 95% CI: 0.54–4.02, P = 0.427). Pre‐intervention, across all sites, 24% of hysterectomies were performed via TAH by the participating specialist trainees, which decreased to 13% during the intervention and 14% during follow‐up. The rate of adverse events decreased from 13.5% at pre‐intervention, to 6.4% during and 4.2% post‐intervention. By comparison, no change in surgical approach or rate of adverse events was observed in the control group.ConclusionsThe implementation of a formal and structured surgical training program teaching TLH resulted in important benefits to trainees, patients and society in the four trial hospitals.

Funder

Medtronic

Metro North Hospital and Health Service

Publisher

Wiley

Subject

Obstetrics and Gynecology,General Medicine

Reference23 articles.

1. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates

2. Surgical approach to hysterectomy for benign gynaecological disease;Aarts JW;Cochrane Database Syst Rev,2015

3. Surgical approach to hysterectomy for benign gynaecological disease;Johnson N;Cochrane Database Syst Rev,2006

4. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: A meta-analysis

5. Hysterectomy‐a comparison of approaches;Müller A;Dtsch Arztebl Int,2010

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