- Email: [email protected]
Review of Hysterectomy Complications in Teaching Hospitals
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S50–S94 Patients: All patients who have a Laparoscopic Hysterectomy are registered in POMT as well as those who have a vaginal hysterectomy or a abdominal hysterectomy. Intervention: Outcome measurements such as complications, conversions, procedure time and bloodloss are registered as well as patient characteristics to define case load. Patient Oucome Measurement Tool (POMT) facilitates to anaylse your own data but even more important it enables to compare your practice with other practices in the country. Measurements and Main Results: Registration started in january 2012. Up untill now 1026 laparoscopic procedures are registered in POMT. In our department the complication rate appeared to be 5% (minor and major complications), comparable to the national complication rate. These are prelinimary results. Correction for case load has not been accomplished yet but will be performed in very near future. Conclusion: POMT facilitates registration of quality of our laparoscopic procedures. Transparency within healthcare providers stimulates surgeons to improve their results. 287
Open Communications 16dHysterectomy (4:14 PMd4:19 PM)
Assessment Tool for Total Laparoscopic Hysterectomy: A Delphi Consensus Survey among International Experts Tremblay C, Grantcharov T, Urquia M, Satkunaratnam A. St. Michael’s Hospital, Toronto, Ontario, Canada Study Objective: To achieve consensus among experts on the essentials steps to include in an assessment tool for total laparoscopic hysterectomy. Design: International survey using the Delphi methodology. Setting: Experts from several countries were selected based on specific criteria, including prior publications in the field of gynecologic laparoscopy, recognition as leaders in laparoscopic surgery according to peers, active involvement in training of advanced laparoscopic surgery and opinion leaders among organizations such as the American Association of Minimally Invasive Gynecology (AAGL) and other well known national gynecologic societies. Intervention: Using a Delphi consensus process, an initial survey was created based on the current literature and local expertise in laparoscopic surgery and sent to selected international experts in laparoscopic gynecology. Eighty-five experts from 8 different countries were invited to participate.
Conclusion: Using a Delphi methodology we achieved international consensus among experts in laparoscopic gynecology within a short timeframe and with minimal costs. The resulting evaluation tool for total laparoscopic hysterectomy may serve in the future in the assessment of surgical skills and would be a valuable adjunct to postgraduate training and continuing medical education programs. 288
Open Communications 16dHysterectomy (4:20 PMd4:25 PM)
Review of Hysterectomy Complications in Teaching Hospitals Singh R,1 Jain N,2 Dandolu V.2 1Obstetrics and Gynecology, Hurley Medical Center, Flint, Michigan; 2Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada Study Objective: To identify whether the rate of complications at hysterectomy in teaching hospitals is different in the first quarter of academic year compared to the remaining year. Design: Retrospective study. Setting: National inpatient database 2005-2007. Patients: Subjects who underwent hysterectomy at teaching hospitals were identified using National Inpatient Sample 2005-2007. Intervention: Mortality, length of stay, Intraoperative ureteric injury and hemorrhage were identified using ICD-9 diagnosis and procedure codes. Cases requiring ureteroneocystotomy and ureteroureterostomy were classified as major ureter injury. Rates were calculated for laparoscopic hysterectomy (Total Laparoscopic, TLH; Laparoscopic assisted subtotal, LASH; Laparoscopic assisted vaginal, LAVH); abdominal hysterectomy (Total abdominal, TAH; Subtotal abdominal, STAH) and vaginal hysterectomy, TVH. Rates during the first quarter of the academic year (July-September) were compared to the rest of the academic year. Measurements and Main Results: A total of 87,299 hysterectomies were included; majority of which were abdominal (48.1%), followed by vaginal (28.1%) and laparoscopic hysterectomies (23.8%). The incidence of major ureteric injuries was highest in vaginal hysterectomy (0.11%) followed by laparoscopic and abdominal hysterectomy (0.04% in each group). Major ureteric injuries were lowest in LAVH (0.02%). The minor ureteric injuries were most common in abdominal hysterectomy (0.77%) followed by laparoscopic hysterectomy (0.4%) and least in vaginal hysterectomy (0.18%). The incidence of acute post hemorrhagic anemia was highest in TAH (1.46%) and least in LAVH (0.41%). The percentage of subjects with length of postoperative stay more than 4 days was highest in TAH (6.85%) and least in LASH (0.72%). Mortality during hospitalization was highest in STAH (0.098%). No difference was seen in the complication rates between first quarter and rest of the academic year. Conclusion: This study demonstrates no difference in complication rates for hysterectomies between first quarter and rest of the academic year in teaching hospitals. It supports evidence from past that blood loss and length of stay is highest in abdominal hysterectomy. 289
Of these, 52 (61%) agreed to participate and 51 (98%) participated in both rounds. After reviewing the initial responses from the participating experts, a second survey was formulated based on the answers and comments from the first round and sent to all experts who participated in the first round. Measurements and Main Results: Consensus was defined as a Cronbach’s alpha R .80 and a rate of agreement R .70 was used to define which substeps to keep in the final tool. Thirty-four of the 56 items from the survey achieved consensus during the first round. The final instrument to assess total laparoscopic hysterectomy was created based on the 39 items that reach consensus after 2 rounds with a Cronbach coefficient of .89.
S89
Open Communications 16dHysterectomy (4:26 PMd4:31 PM)
Comparison of the Use of LigaSure, Halo PKS Cutting Forceps and EnSeal Tissue Sealer in Total Laparoscopic Hysterectomy: A Randomized Trial Aytan H,1 Nazik H,2 Narin R,2 Api M.2 1Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey; 2Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey Study Objective: There are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy. The aim of the study is to compare LigaSure, HALO PKS Cutting Forceps and EnSeal Tissue Sealer, in total
Open Communications 16dHysterectomy (4:14 PMd4:19 PM)
Assessment Tool for Total Laparoscopic Hysterectomy: A Delphi Consensus Survey among International Experts Tremblay C, Grantcharov T, Urquia M, Satkunaratnam A. St. Michael’s Hospital, Toronto, Ontario, Canada Study Objective: To achieve consensus among experts on the essentials steps to include in an assessment tool for total laparoscopic hysterectomy. Design: International survey using the Delphi methodology. Setting: Experts from several countries were selected based on specific criteria, including prior publications in the field of gynecologic laparoscopy, recognition as leaders in laparoscopic surgery according to peers, active involvement in training of advanced laparoscopic surgery and opinion leaders among organizations such as the American Association of Minimally Invasive Gynecology (AAGL) and other well known national gynecologic societies. Intervention: Using a Delphi consensus process, an initial survey was created based on the current literature and local expertise in laparoscopic surgery and sent to selected international experts in laparoscopic gynecology. Eighty-five experts from 8 different countries were invited to participate.
Conclusion: Using a Delphi methodology we achieved international consensus among experts in laparoscopic gynecology within a short timeframe and with minimal costs. The resulting evaluation tool for total laparoscopic hysterectomy may serve in the future in the assessment of surgical skills and would be a valuable adjunct to postgraduate training and continuing medical education programs. 288
Open Communications 16dHysterectomy (4:20 PMd4:25 PM)
Review of Hysterectomy Complications in Teaching Hospitals Singh R,1 Jain N,2 Dandolu V.2 1Obstetrics and Gynecology, Hurley Medical Center, Flint, Michigan; 2Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, Nevada Study Objective: To identify whether the rate of complications at hysterectomy in teaching hospitals is different in the first quarter of academic year compared to the remaining year. Design: Retrospective study. Setting: National inpatient database 2005-2007. Patients: Subjects who underwent hysterectomy at teaching hospitals were identified using National Inpatient Sample 2005-2007. Intervention: Mortality, length of stay, Intraoperative ureteric injury and hemorrhage were identified using ICD-9 diagnosis and procedure codes. Cases requiring ureteroneocystotomy and ureteroureterostomy were classified as major ureter injury. Rates were calculated for laparoscopic hysterectomy (Total Laparoscopic, TLH; Laparoscopic assisted subtotal, LASH; Laparoscopic assisted vaginal, LAVH); abdominal hysterectomy (Total abdominal, TAH; Subtotal abdominal, STAH) and vaginal hysterectomy, TVH. Rates during the first quarter of the academic year (July-September) were compared to the rest of the academic year. Measurements and Main Results: A total of 87,299 hysterectomies were included; majority of which were abdominal (48.1%), followed by vaginal (28.1%) and laparoscopic hysterectomies (23.8%). The incidence of major ureteric injuries was highest in vaginal hysterectomy (0.11%) followed by laparoscopic and abdominal hysterectomy (0.04% in each group). Major ureteric injuries were lowest in LAVH (0.02%). The minor ureteric injuries were most common in abdominal hysterectomy (0.77%) followed by laparoscopic hysterectomy (0.4%) and least in vaginal hysterectomy (0.18%). The incidence of acute post hemorrhagic anemia was highest in TAH (1.46%) and least in LAVH (0.41%). The percentage of subjects with length of postoperative stay more than 4 days was highest in TAH (6.85%) and least in LASH (0.72%). Mortality during hospitalization was highest in STAH (0.098%). No difference was seen in the complication rates between first quarter and rest of the academic year. Conclusion: This study demonstrates no difference in complication rates for hysterectomies between first quarter and rest of the academic year in teaching hospitals. It supports evidence from past that blood loss and length of stay is highest in abdominal hysterectomy. 289
Of these, 52 (61%) agreed to participate and 51 (98%) participated in both rounds. After reviewing the initial responses from the participating experts, a second survey was formulated based on the answers and comments from the first round and sent to all experts who participated in the first round. Measurements and Main Results: Consensus was defined as a Cronbach’s alpha R .80 and a rate of agreement R .70 was used to define which substeps to keep in the final tool. Thirty-four of the 56 items from the survey achieved consensus during the first round. The final instrument to assess total laparoscopic hysterectomy was created based on the 39 items that reach consensus after 2 rounds with a Cronbach coefficient of .89.
S89
Open Communications 16dHysterectomy (4:26 PMd4:31 PM)
Comparison of the Use of LigaSure, Halo PKS Cutting Forceps and EnSeal Tissue Sealer in Total Laparoscopic Hysterectomy: A Randomized Trial Aytan H,1 Nazik H,2 Narin R,2 Api M.2 1Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey; 2Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey Study Objective: There are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy. The aim of the study is to compare LigaSure, HALO PKS Cutting Forceps and EnSeal Tissue Sealer, in total