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Minimally invasive specialists and rates of laparoscopic hysterectomy.

Loring M, Morris SN, Isaacson KB - JSLS (2015 Jan-Mar)

Bottom Line: 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.Secondary outcomes of interest included length of stay and factors associated with an open procedure.This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists.

View Article: PubMed Central - PubMed

Affiliation: Center for Minimally Invasive Gynecologic Surgery Newton-Wellesley Hospital, Newton, Massachusetts.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Increasing rate of outpatient laparoscopic hysterectomy compared to declining inpatient laparoscopic hysterectomy by year at Newton-Wellesley Hospital.
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Related In: Results  -  Collection

License
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Figure 2: Increasing rate of outpatient laparoscopic hysterectomy compared to declining inpatient laparoscopic hysterectomy by year at Newton-Wellesley Hospital.

Mentions: In 2004, only 2 of 194 laparoscopic hysterectomies were performed on an outpatient basis. By 2010, 60% (163/269) were outpatient, and by 2012, the frequency grew to more than 85% (293/344; Figure 2).


Minimally invasive specialists and rates of laparoscopic hysterectomy.

Loring M, Morris SN, Isaacson KB - JSLS (2015 Jan-Mar)

Increasing rate of outpatient laparoscopic hysterectomy compared to declining inpatient laparoscopic hysterectomy by year at Newton-Wellesley Hospital.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376222&req=5

Figure 2: Increasing rate of outpatient laparoscopic hysterectomy compared to declining inpatient laparoscopic hysterectomy by year at Newton-Wellesley Hospital.
Mentions: In 2004, only 2 of 194 laparoscopic hysterectomies were performed on an outpatient basis. By 2010, 60% (163/269) were outpatient, and by 2012, the frequency grew to more than 85% (293/344; Figure 2).

Bottom Line: 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.Secondary outcomes of interest included length of stay and factors associated with an open procedure.This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists.

View Article: PubMed Central - PubMed

Affiliation: Center for Minimally Invasive Gynecologic Surgery Newton-Wellesley Hospital, Newton, Massachusetts.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus