Teach the Teachers: An Observational Study on Mentor Traineeship in Gynecological Laparoscopic Surgery

Abstract

Background: To evaluate the effect of a mentor traineeship in laparoscopic surgery in a teaching hospital. Method: This observational study was performed between January 1997 and December 2004 at Bronovo Hospital, The Hague, The Netherlands. Since January 2001, an advanced endoscopic gynecologist has mentored a trainee in laparoscopic surgery. Data on the trainee’s procedures preceding (1997–2000) and during the mentor traineeship (2001–2004) were compared. The number and type of procedures performed, complications and conversions were derived from a prospectively kept database supplemented by a retrospective chart review. Operating times for total laparoscopic hysterectomy (TLH) were registered to establish the trainee’s learning curve. Results: Since the presence of a mentor, the trainee has performed significantly more advanced laparoscopic procedures. Despite the significant increase in advanced cases, the trainee’s laparoscopic conversion rate to laparotomy remained stable between period 1 and period 2 (7.5 and 4.5%, respectively, p = 0.35, 95% CI –0.033 to 0.092); moreover, for level-3 procedures the conversion rate decreased (p < 0.001, 95% CI 0.30–0.71). Despite the increase in advanced cases, the total complication rate remained stable (3.2–4.5%, p = 0.62, 95% CI –0.07 to 0.04) including the number of level-3 complications (p = 0.63, 95% CI –0.4 to 0.3). A decreasing trend in operating time for TLH was found; however, this was not significant (Spearman correlation coefficient –0.421, p = 0.81). Conclusions: Mentor traineeship in gynecology enhanced the advanced laparoscopic caseload. With the increase in advanced procedures, no increase in conversion rate, complication rate or operating times for TLH was found. Due to the mentorship, patients were not exposed to increased complications and conversions, or to the disadvantages of a prolonged operating time. Predominantly, mentor traineeship facilitated the implementation of laparoscopic surgery into an established gynecological practice in a teaching hospital.

Short-term surgical outcome and safety of risk reducing salpingo-oophorectomy in BRCA1/2 mutation carriers

“…It is known that education by a mentor traineeship is accompanied by a low complication rate and a stable conversion rate [17]. The current study, in which all patients were operated in a mentor traineeship setting, showed a low complication and conversion rate comparable to the results of Kolkman et al [17].…”

“…The intraoperative complication rate (1.3%) in the current study is lower than reported in the study by Meeuwissen et al [12] and comparable to the complication rate published by Kauff et al [13]. In the Netherlands several studies have evaluated the gynaecological laparoscopic skills under residents [17,18]. It is known that education by a mentor traineeship is accompanied by a low complication rate and a stable conversion rate [17].…”

Implementing an Advanced Laparoscopic Procedure by Monitoring with a Visiting Surgeon

“…Guided learning curves have been described previously, and it has been suggested that they result in fewer complications during the learning curve [15,20]. However, when implementing a new technique in this manner in an Table 4 Conversions to laparotomy during study established practice, a few previous conditions should be met.…”

“…1). The OSATS included 7 items (respect for tissue, time and motion, instrument handling, knowledge of instruments, use of assistance, flow of operation, and knowledge of the specific procedure) scored on a scale of 0 to a maximum of 5 points per item [15]. If a participating gynecologist reached a minimum score of 4 on each item (7 !…”

“…It is an instrument to measure quality of surgical skills rather than counting the number of performed procedures (quantity). In addition to monitoring skills, it has been suggested that mentorship during the learning curve of an advanced laparoscopic procedure facilitates its implementation and warrants the safety of the patient [14,15]. Laparoscopic hysterectomy is not the standard treatment in patients with an indication for abdominal hysterectomy in many countries, although benefits have been described.…”