Hospital versus individual surgeon’s performance in laparoscopic hysterectomy

Driessen, Sara R. C.; Wallwiener, Markus; Taran, Florin‐Andrei; Cohen, Sarah L.; Kraemer, Bernhard; Wallwiener, Christian W.; Zwet, Erik W. van; Brucker, Sara; Jansen, Frank Willem

doi:10.1007/s00404-016-4199-2

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…The impact of this factor was greater than that of the weekly number of operations as a surgeon or the years of experience in minimally invasive surgery. This observation confirms a previous statement to the effect that the absolute number of operations, that is the quantitative experience of a surgeon, is a good predictor of surgical success 7 , 8 , 21 , 22 . This is also reflected in many certification programs, which prescribe the absolute number of specific surgeries as a defining requirement 23 .…”

Section: Discussionsupporting

confidence: 91%

Factors influencing surgical performance and learning progress in minimally invasive surgery – results of an interdisciplinary muticenter study

Ackermann

Baumann

Pape

et al. 2023

International Journal of Surgery

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Background: Advancing surgical techniques require a high level of adaptation and learning skills on the part of surgeons. We need selection procedures and decision support systems for the recruitment of medical students and young surgeons. We aimed to investigate factors influencing the surgical performance and learning abilities of surgeons and medical students. Material and Methods: The training scores of persons attending 16 standardized training courses (at three training centers) of the German Working Group for Gynecological Endoscopy (AGE e.V.) from 2017 to 2020, individual characteristics, and the results of psychomotor tests of three-dimensional imagination and hand-eye coordination were correlated. Similar analyses were performed for medical students in their final clinical year from 2019 to 2020. The training concept was evaluated in a prospective, multicenter, interdisciplinary, multinational setting. Results: In all, 180 of 206 physicians (response rate 87.4%) and 261 medical students (response rate 100%) completed the multi-stage training concept successfully. Of personal characteristics, the strongest correlation was noted for good surgical performance and learning success, and the absolute number of performed laparoscopic surgeries (r=0.28-0.45, P<0.001/r=0.1-0.28, P<0.05). A high score on the spatial visualization ability test was also correlated with good surgical performance (r=0.18-0.27, P<0.01). Among medical students with no surgical experience, however, age was negatively correlated with surgical performance, i.e. the higher the age, the lower the surgical performance (r=0.13/r=0.22, P<0.05/P<0.001). Conclusion: Individual factors (e.g. surgical experience, self-assessment, spatial visualization ability, eye-hand coordination, age) influence surgical performance and learning. Further research will be needed to create better decision support systems and selection procedures for prospective physicians. The possibilities of surgical training should be improved, promoted, and made accessible to a maximum number of surgical trainees because individual learning curves can be overcome even by less talented surgeons. Training options should be institutionalized for those attending medical school.

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Section: Discussionsupporting

confidence: 91%

Factors influencing surgical performance and learning progress in minimally invasive surgery – results of an interdisciplinary muticenter study

Ackermann

Baumann

Pape

et al. 2023

International Journal of Surgery

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“…Attempts are being made to provide these individual outcomes. 54 Another potential limitation is the exclusion of VH with pelvic organ prolapse indication from analysis. This might underestimate the absolute numbers of VH in the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

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

Tummers

Hoebink

Driessen

et al. 2021

Acta Obstet Gynecol Scand

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“…A binary variable for composite adverse outcome was generated on the basis of the patient's intraoperative and postoperative course. Intraoperative adverse outcomes were defined as blood loss >500 mL, conversion to open procedure, need for transfusion, operative time >4 hours, and organ injury (including bowel, bladder, ureter, or vascular) [24]. Prolonged operative time was included as a marker of a difficult procedure.…”

Section: Methodsmentioning

confidence: 99%

Risk-prediction Model for Patients Undergoing Laparoscopic Hysterectomy

Pepin

Cook

Maghsoudlou

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: Develop a model for predicting adverse outcomes at the time of laparoscopic hysterectomy (LH) for benign indications. Design: Retrospective cohort study. Setting: Large academic center. Patients: All patients undergoing LH for benign indications at our institution between 2009 and 2017. Interventions: LH (including robot-assisted and laparoscopically assisted vaginal hysterectomy) was performed per standard technique. Data about the patient, surgeon, perioperative adverse outcomes (intraoperative complications, readmission, reoperation, operative time >4 hours, and postoperative medical complications or length of stay >2 days), and uterine weight were collected retrospectively. Pathologic uterine weight was used as a surrogate for predicted preoperative uterine weight. The sample was randomly split, using a random sequence generator, into 2 cohorts, one for deriving the model and the other to validate the model. Measurements and Main Results: A total of 3441 patients were included. The rate of composite adverse outcomes was 14.1%. The final logistic regression risk-prediction model identified 6 variables predictive of an adverse outcome at the time of LH: race, history of laparotomy, history of laparoscopy, predicted preoperative uterine weight, body mass index, and surgeon annual case volume. Specifically included were race (97% increased odds of an adverse outcome for black women [95% confidence interval (CI), 34%−110%] and 34% increased odds of an adverse outcome for women of other races [95% CI, −11% to 104%] when compared with white women), history of laparotomy (69% increased odds of an adverse outcome [95% CI, 26%−128%]), history of laparoscopy (65% increased odds of an adverse outcome [95% CI, 21%−124%]), and predicted preoperative uterine weight (2.9% increased odds of an adverse outcome for each 100-g increase in predicted weight [95% CI, 2%−4%]). Body mass index and surgeon annual case volume also had a statistically significant nonlinear relationship with the risk of an adverse outcome. The c-statistic values for the derivation and validation cohorts were 0.74 and 0.72, respectively. The model is best calibrated for patients at lower risk (<20%). Conclusion:The LH risk-prediction model is a potentially powerful tool for predicting adverse outcomes in patients planning hysterectomy.

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Hospital versus individual surgeon’s performance in laparoscopic hysterectomy

Cited by 7 publications

References 17 publications

Factors influencing surgical performance and learning progress in minimally invasive surgery – results of an interdisciplinary muticenter study

Factors influencing surgical performance and learning progress in minimally invasive surgery – results of an interdisciplinary muticenter study

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

Risk-prediction Model for Patients Undergoing Laparoscopic Hysterectomy

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