The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-02-01 DOI:10.1016/j.jmig.2024.09.012

Raanan Meyer MD , Rebecca J. Schneyer MD , Kacey M. Hamilton MD , Gabriel Levin MD , Mireille D. Truong MD , Matthew T. Siedhoff MD, MSCR , Kelly N. Wright MD

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引用次数: 0

Abstract

Study Objective

To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GOs), or general obstetrician/gynecologists (OB/GYNs).

Design

Retrospective cohort study.

Setting

Quaternary care academic hospital.

Patients

Patients undergoing MIH for benign indications from March 2015 to March 2020 were included.

Interventions

MIH.

Measurements and Main Results

The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons’ group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.36–3.71), and 25.9% of the OB/GYN group (OR, 2.65; 95% CI, 1.70–4.12). Major intra- or postoperative complications were associated with surgeons’ groups (OR, 7.02; 95% CI, 2.67–18.47, and OR, 6.84; 95% CI, 2.73–17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%; OR, 7.21; 95% CI, 2.52–20.60) and OB/GYNs (9.7%; OR, 7.82; 95% CI, 2.90–21.06). There was a higher odd of postoperative complications for OB/GYNs than MIGS (18.5% vs 10.9%; OR, 1.86; 95% CI, 1.16–3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared with GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs than MIGS surgeons (OR, 2.12; 95% CI, 1.07–4.22; OR, 2.48; 95% CI, 1.49–4.12, respectively).

Conclusion

Fellowship-trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.

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微创妇科手术亚专业培训对良性腹腔镜子宫切除术结果的影响--一项回顾性队列研究。

研究目的比较接受腹腔镜或机器人微创子宫切除术（MIH）的患者与微创妇科手术（MIGS）亚专科医生、妇科肿瘤学家（GO）或普通妇产科医生（OB/GYN）的手术效果：设计：回顾性队列研究：患者或参与者：纳入2015年3月至2020年3月期间因良性适应症接受MIH的患者：测量和主要结果：主要结果是手术后30天内出现任何术中或术后并发症的几率，按外科医生分组。研究期间共进行了728例MIH，其中368例（50.5%）由妇产科医生实施，144例（19.8%）由普通外科医生实施，216例（29.7%）由妇产科医生实施。术中和术后并发症的发生率分别为：MIGS 组 11.7%、GO 组 22.9%（OR 2.25，95%CI 1.36-3.71）和 OB/GYN 组 25.9%（OR 2.65，95%CI 1.70-4.12）。主要术中或术后并发症与外科医生组别有关（与 MIGS 相比，GO 组和 OB/GYN 组的 OR 分别为 7.02 95%CI 2.67-18.47 和 6.84 95%CI 2.73-17.16）。MIGS 外科医生的术中并发症发生率（1.4%）明显低于 GO 外科医生（9.0%，OR 7.21 95%CI 2.52-20.60）和 OB/GYN 外科医生（9.7%，OR 7.82 95%CI 2.90-21.06）。妇产科医生的术后并发症发生率高于妇产科医生（18.5% 对 10.9%，OR 1.86 95%CI 1.16-3.00）。与普通外科医生（7.6%）和妇产科医生（7.9%）相比，妇产科医生转为开腹手术的比例最低（0.3%）。与 MIGS 外科医生相比，估计失血量第 90 百分位数或更高和手术时间第 90 百分位数或更高的情况在妇产科医生中更为常见（OR 2.12 95%CI 1.07-4.22；OR 2.48 95%CI 1.49-4.12）：经过研究员培训的MIGS亚专科医生与GO和妇产科医生相比，良性MIH的手术效果更好，围手术期并发症发生率更低，转为开腹手术的情况更少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.