Increasing Minimally Invasive Hysterectomy: A Canadian Academic Health Centre Experience

Gale, Jenna; Cameron, Chris; Chen, Innie; Guo, Yanfang; Singh, Sukhbir S.

doi:10.1016/j.jogc.2015.12.004

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…Winnipeg is underperforming minimally invasive hysterectomy relative to national averages and has not improved over the last 8 years. In contrast, other centers across Canada have made significant improvements in performance in recent years, 7,13,14,18 which demonstrates that change is possible in the Canadian context.…”

Section: Discussionmentioning

confidence: 98%

“…18 Ottawa, Ontario has demonstrated the greatest published national improvement from a TI of 40.1% in 2005 to 74.2% in 2012. 7 As a province, Quebec improved from 39.9% in 2002 to 44.3% in 2008. 19 Winnipeg, Manitoba provides healthcare services for benign and malignant gynecologic disease to much of the province of Manitoba and some of Nunavut and Northwestern Ontario.…”

mentioning

confidence: 99%

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Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective Cross-Sectional Database Review

Evans

Burnett

2018

Hosp Pract Res

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective Cross-Sectional Database Review

Evans

Burnett

2018

Hosp Pract Res

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“…For the programme to be worthwhile, we wish to decrease TAH by 30% in 75% of the trainees. We assume that a higher TLH rate will translate into better patient health outcomes including surgical AEs30 36; a drop in TAH by 30% is clinically relevant. The primary outcome of the proportion of TAH procedures will be analysed within each site using χ 2 test.…”

Section: Methods and Analysismentioning

confidence: 99%

“…In parallel, postoperative complications also decreased significantly 17 29. In Canada, between 2005 and 2012, the proportion of hysterectomies conducted by TLH increased from 40% to 74% through stakeholder engagement and structured learning 30…”

Section: Rationalementioning

confidence: 99%

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

Obermair

Armfield

Graves³

et al. 2019

BMJ Open

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IntroductionHysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH).Methods and analysisStepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals.Primary outcomesChange in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention; we aim to reduce TAH by at least 30% in 75% of the trainees.Secondary outcomes(1) Number of hospitals screened, eligible, agree to training and complete the training; (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency; (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure; change in proportion proficient over time; (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay >7 days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection); (5) hospital length-of-stay; (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH.Ethics and disseminationThe study has been approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03617354; Pre-results.

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“…Because of its faster recovery period and lower number of complications compared with conventional abdominal approaches, it has become the default mode of hysterectomy for many gynaecologists across Canada. 11,12 Surgeon uptake of laparoscopic hysterectomy appears to be multifactorial, and self-reports of adequate training and availability of operating room resources appear to be important variables. 13 A 1983 report by Kilkku et al suggested an association between reduced sexual function and removal of the cervix and led to an increasing number of subtotal (supracervical) hysterectomies.…”

mentioning

confidence: 99%

Hysterectomy Trends: A Canadian Perspective on the Past, Present, and Future

Chen

Choudhry

Tulandi

2019

Journal of Obstetrics and Gynaecology Canada

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W ith more than 41 000 hysterectomies performed annually in Canada, surgical removal of the uterus is a cornerstone of gynaecologic surgery. 1 Soranus of Ephesus is credited with performing the first hysterectomy in the second century CE. He removed a gangrenous prolapsed uterus vaginally; however, the bladder and ureters were also transected. 2 Another notable case is that of Faith Howard, who in 1670 performed an auto-amputation for a completely prolapsed uterus. Although she survived the surgery, she experienced "water passing from her insensible day and night." 3

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Increasing Minimally Invasive Hysterectomy: A Canadian Academic Health Centre Experience

Cited by 15 publications

References 10 publications

Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective Cross-Sectional Database Review

Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective Cross-Sectional Database Review

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

Hysterectomy Trends: A Canadian Perspective on the Past, Present, and Future

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