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Zeppernick F, Zeppernick M, Wölfler MM, Janschek E, Holtmann L, Bornemann S, Oehmke F, Salehin D, Scheible CM, Brandes I, Vingerhagen-Pethick S, Cornelius CP, Boosz A, Krämer B, Sillem M, Keckstein J, Schweppe KW, Meinhold-Heerlein I. Surgical Treatment of Patients with Endometriosis in the Certified Endometriosis Centers of the DACH Region - A Subanalysis of the Quality Assurance Study QS ENDO pilot. Geburtshilfe Frauenheilkd 2024; 84:646-655. [PMID: 38993799 PMCID: PMC11233201 DOI: 10.1055/a-2324-3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/09/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction After puberty, at least 10% of all women and girls suffer from endometriosis. Surgery is useful for both the diagnosis and therapy. To date, quality indicators for the surgical treatment of endometriosis are lacking. QS ENDO aims to record the quality of care provided in the DACH region and to introduce quality indicators for the diagnosis and treatment of endometriosis. In the first phase of the study, QS ENDO real, the reality of care was recorded using a questionnaire. The second phase, QS ENDO pilot, investigated the treatment of patients who underwent surgery in certified endometriosis centers in a defined time-period. Material and Methods The surgical data of 10 patients from each of the 44 endometriosis centers in the DACH region was recorded using an online tool. Collected data included the approach used, the endometriosis phenotype, a description of the surgical site, resection status, histological confirmation, the use of a classification, and any complications. All operations were carried out in October 2016 as the defined time-period. The surgical approaches used were compared with the recommendations in the current guidelines. Results The data of 435 patients with a median age of 34 years were evaluated. 315 (72.4%) were nulliparous. 120 patients had given birth to at least one child and 42.5% (51) of them had delivered their child by caesarean section. About 50% of all patients also had deep infiltrating endometriosis in addition to ovarian endometriosis, and the median NAS score was 7.5. With regards to the surgical treatment, endometriomas were completely resected in 81% (94) of patients. 87.3% of patients underwent resection of peritoneal endometriosis. Forty-one patients had a hysterectomy, with a total hysterectomy carried out in 26 (63.4%) and a supracervical hysterectomy in 15 (36.6%) patients. Of the 59 patients with bowel endometriosis, half had segmental resection and half had shaving of the anterior rectal wall. Complications requiring revision occurred in 0.9% of cases. Conclusion The surgical procedures carried out in the certified endometriosis centers of the DACH region are largely in line with the recommendations for appropriate surgical approaches in the current standard guidelines.
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Affiliation(s)
- Felix Zeppernick
- Zentrum für Frauenheilkunde und Geburtshilfe der Justus Liebig-Universität Gießen, Gießen, Germany
| | - Magdalena Zeppernick
- Zentrum für Frauenheilkunde und Geburtshilfe der Justus Liebig-Universität Gießen, Gießen, Germany
| | | | | | | | | | - Frank Oehmke
- Zentrum für Frauenheilkunde und Geburtshilfe der Justus Liebig-Universität Gießen, Gießen, Germany
| | - Darius Salehin
- Johanniter GmbH; Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Chi Mi Scheible
- Johanniter GmbH; Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Iris Brandes
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | | | - Martin Sillem
- Stiftung Endometriose-Forschung, Westerstede, Germany
- Praxisklinik am Rosengarten, Mannheim, Germany
| | - Jörg Keckstein
- Stiftung Endometriose-Forschung, Westerstede, Germany
- Endometriosezentrum Keckstein, Villach, Austria
| | | | - Ivo Meinhold-Heerlein
- Zentrum für Frauenheilkunde und Geburtshilfe der Justus Liebig-Universität Gießen, Gießen, Germany
- Stiftung Endometriose-Forschung, Westerstede, Germany
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Schützendübel M, Boosz A, Baev E, Häberle L, Müller A. Learning laparoscopic hysterectomy: analysis of different surgeons' individual learning curves. Arch Gynecol Obstet 2023; 307:1065-1072. [PMID: 36580116 DOI: 10.1007/s00404-022-06893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to examine the development of surgical skills among surgeons learning total laparoscopic hysterectomy (TLH), using differences in complication rates between surgeons with different levels of experience and analyzing the development of individual operating times. STUDY DESIGN This retrospective, single-center cohort study included 576 total laparoscopic hysterectomy procedures conducted between January 2015 and December 2019 at the municipal hospital in Karlsruhe, Germany. All TLHs were performed by eight surgeons, two of whom were experienced and six inexperienced. Complications were graded using the Clavien-Dindo classification. RESULTS No differences in complication rates were seen between experienced and inexperienced surgeons. With growing numbers of procedures, most surgeons quickly became faster, leading to reduced operating times. However, experienced surgeons who had performed more than 100 procedures also became faster, not reaching a time plateau after adjustment for weight of the uterus, presurgery score, and adnexal score. CONCLUSIONS Learning laparoscopic hysterectomy in routine practice is safe for patients, and surgeons rapidly become faster as growing numbers of procedures are performed. Operating times for experienced surgeons who have carried out more than 100 operations also improve, and a time plateau is not reached.
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Affiliation(s)
- Malte Schützendübel
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany.
- Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Alexander Boosz
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Evgeni Baev
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Lothar Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
- Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS). Arch Gynecol Obstet 2023; 307:827-840. [PMID: 36342536 PMCID: PMC9984324 DOI: 10.1007/s00404-022-06796-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To limit the burden of long-term immunosuppression (IS) after uterus transplantation (UTx), removal of the uterine allograft is indicated after maximum two pregnancies. Hitherto this has required graft hysterectomy by laparotomy. Our objective was to demonstrate, as a proof of concept, the feasibility of less traumatic transplantectomy by total laparoscopic hysterectomy (TLH). PATIENT A 37-year-old woman with uterovaginal agenesis due to Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who had undergone neovaginoplasty at age 19 years prior to living-donor (LD) UTx in 10/2019 at age 35 years gave birth to a healthy boy by primary cesarean section in 06/2021. During pregnancy, she developed impaired renal function, with bilateral hydronephrosis, necessitating early allograft removal in 09/2021 to prevent chronic kidney disease, particularly during a potential second pregnancy. METHODS Transplantectomy by TLH essentially followed standard TLH procedures. We paid meticulous attention to removing as much donor tissue as possible to prevent postoperative complications from residual donor tissue after stopping IS, as well as long-term vascular damage. RESULTS TLH was performed successfully without the need to convert to open surgery. Surgical time was 90 min with minimal blood loss. No major complications occurred intra- or postoperatively and during the subsequent 9-month follow-up period. Kidney function normalized. CONCLUSIONS To our knowledge, we report the first successful TLH-based removal of a uterine allograft in a primipara after LD UTx, thus demonstrating the feasibility of TLH in uterus recipients with MRKHS.
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Binder S, Boosz A, Kolioulis I, Baev E, Müller N, Krämer J, Müller A. Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery. Arch Gynecol Obstet 2022; 306:1617-1621. [PMID: 35916959 DOI: 10.1007/s00404-022-06714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery. METHODS A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury. RESULTS In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations. CONCLUSION Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations.
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Affiliation(s)
- Simon Binder
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany. .,Department of Gynecology and Obstetrics, Diakonissenkrankenhaus Karlsruhe, Diakonissenstraße 28, 76199, Karlsruhe, Germany.
| | - Alexander Boosz
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Ioannis Kolioulis
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Evgeni Baev
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Nadine Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Janine Krämer
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Karlsruhe, Germany
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Vermeulen CKM, Veen J, Adang C, van Leijsen SAL, Coolen ALWM, Bongers MY. Pelvic organ prolapse after laparoscopic hysterectomy compared with vaginal hysterectomy: the POP-UP study. Int Urogynecol J 2020; 32:841-850. [PMID: 33170314 PMCID: PMC8009772 DOI: 10.1007/s00192-020-04591-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to review the long-term prevalence of pelvic organ prolapse (POP) after laparoscopic hysterectomy (LH) compared with vaginal hysterectomy (VH). METHODS An observational cohort study was conducted amongst women who underwent an LH or a VH for benign indications during the period 1996-2004: the POP-UP study. The prevalence of POP was inventoried by a questionnaire involving the Pelvic Floor Distress Inventory (PFDI-20) and a pelvic floor examination (POP-Q). Women were divided into groups based on route and indication of hysterectomy: LH, VH-1 (for nonprolapse), and VH-2 (prolapse). RESULTS Four hundred and six of the 706 eligible patients (58%) returned the questionnaire and 247 underwent POP-Q examination. Sixty-eight patients (17%) received treatment for prolapse; 8% LH, 10% VH-1, and 29% VH-2 (Chi-squared test, p < 0.001). The prevalence of vaginal vault prolapse (apical surgery or ≥ stage 2 at POP-Q) was 4.4% for LH and 5.8% for VH-1 (p = 0.707); and 23% for VH-2 (VH-2 versus others, p < 0.0001). The prevalence of prolapse ≥ stage 2 in any compartment was 62% (n = 153) in total and in 42% of the LH group, 51% of the VH-1 group, and 84% of the VH-2 group (Chi-squared test, p < 0.001). A symptomatic POP (anatomical POP ≥ stage 2 with bulging) was present in 11% of the population. CONCLUSIONS No difference was found in the prevalence of POP between LH and VH for nonprolapse indications. However, POP after VH for prolapse occurs more frequently than after hysterectomy for other indications.
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands.
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
| | - Joggem Veen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Caroline Adang
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
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AlAshqar A, Goktepe ME, Kilic GS, Borahay MA. Predictors of the cost of hysterectomy for benign indications. J Gynecol Obstet Hum Reprod 2020; 50:101936. [PMID: 33039600 DOI: 10.1016/j.jogoh.2020.101936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hysterectomy is a commonly performed procedure with widely variable costs. As gynecologists divert from invasive to minimally invasive approaches, many factors come into play in determining hysterectomy cost and efforts should be sought to minimize it. Our objective was to identify the predictors of hysterectomy cost. MATERIALS AND METHODS This was a retrospective cohort study where women who underwent hysterectomy for benign conditions at the University of Texas Medical Branch from 2009 to 2016 were identified. We obtained and analyzed demographic, operative, and financial data from electronic medical records and the hospital finance department. RESULTS We identified 1,847 women. Open hysterectomy was the most frequently practiced (35.8 %), followed by vaginal (23.7 %), laparoscopic (23.6 %), and robotic (16.9 %) approaches. Multivariate regression demonstrated that hysterectomy charges can be significantly predicted from surgical approach, patient's age, operating room (OR) time, length of stay (LOS), estimated blood loss, insurance type, fiscal year, and concomitant procedures. Charges increased by $3,723.57 for each day increase in LOS (P <0.001), by $76.02 for each minute increase in OR time (P <0.001), and by $48.21 for each one-year increase in age (P 0.037). Adjusting for LOS and OR time remarkably decreased the cost of open and robotic hysterectomy, respectively when compared with the vaginal approach. CONCLUSION Multiple demographic and operative factors can predict the cost of hysterectomy. Healthcare providers, including gynecologists, are required to pursue additional roles in proper resource management and be acquainted with the cost drivers of therapeutic interventions. Future efforts and policies should target modifiable factors to minimize cost and promote value-based practices.
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Affiliation(s)
- Abdelrahman AlAshqar
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States; Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait
| | - Metin E Goktepe
- Medical Student, The University of Texas Medical Branch in Galveston, TX, United States
| | - Gokhan S Kilic
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, TX, United States
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States.
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Occult Malignancy Rate of 1498 Hysterectomies or Myomectomies with Morcellation: A Retrospective Single-Arm Study. J Obstet Gynaecol India 2018; 69:188-193. [PMID: 31686755 DOI: 10.1007/s13224-018-1190-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022] Open
Abstract
Background and Purpose Since April 2014, the FDA warns against the use of morcellation during minimally invasive uterine surgery because of the risk of occult malignant spreading in the abdominal cavity. It is clear, however, that more studies are needed to define the incidence of occult uterine cancers, its risk factors, preoperative identification and postoperative follow-up. The present retrospective single-arm study defines the prevalence of occult uterine malignancies in a large group of patients treated with hysterectomy or myomectomy for benign indications. Methods In the year of 2014, 1498 women admitted for a myomectomy or hysterectomy in benign conditions at the clinic of minimally invasive surgery (Minimal Invasive Chirurgie or MIC) in Berlin (Germany) were included in this study. The morcellated uterine specimens of operated patients were histologically analyzed for the presence of cancerous tissue. Results We detected malignancies in three of the 1498 women (0.2%): two patients had endometrial cancer, while we observed cervical cancer in situ in the third patient. No sarcoma was found. Conclusion We detected a very low prevalence of occult uterine malignancy which is in line with several other recent studies. To define a clear policy on the use of morcellation, more studies are required. In the meantime, patients should be informed about the risks of morcellation in case of undetected cancer prior to surgery.
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Ortiz-Martínez RA, Betancourt-Cañas AJ, Bolaños-Náñez DM, Cardona-Narváez T, Portilla ED, Flórez-Victoria O. Prevalence of surgical complications in gynecological surgery at the Hospital Universitario San José in Popayán, Colombia. 2015. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n4.63743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Every surgery has risk of complications; prognosis depends on prompt diagnosis and timely management.Objective: To determine the prevalence of surgical complications in gynecological surgery in a tertiary care hospital and to explore associated factors.Materials and methods: Prevalence study with secondary analysis of medical records of patients who underwent scheduled gynecological surgery. The outcome variable was complications reported during a period of less than 30 days. The universe was established, and clinical, biological and sociodemographic variables were collected. To determine prevalence, the total number of complications was taken as the numerator and the total number of records was used as the denominator. To explore associated factors, odds ratio (OR) was used as a measure of association with a 95% CI.Results: 591 records were reviewed, finding a surgical management of ectopic pregnancy prevalence of 3.8% (OR=3.73, CI95%: 2.41-92.52). Obesity (OR 12.47, CI95%: 4.48-33.19) and gynecological surgery for malignancy (OR 3.73, CI95%: 1.14- 10.48) were associated with complications.Conclusion: The prevalence found in our institution was similar to what most studies have reported.
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Hildebrandt T, Emir S, Boosz A, Beckmann MW, Müller A. Total laparoscopic hysterectomy: how does training for surgeons in a standardized operation affect hospitals and patients? Arch Gynecol Obstet 2018; 298:763-771. [PMID: 30099567 DOI: 10.1007/s00404-018-4869-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Surgical training usually means inexperienced physicians initially doing operations supervised by an experienced physician, to gain the experience and skills needed to conduct surgery independently. Various issues arise here for both hospitals and patients. Are training procedures associated with higher complication rates, blood losses, and transfusion rates? What does training in the operating room ultimately cost in terms of valuable surgical time? Do longer hospitalization periods potentially mean financial losses for the hospital under the diagnosis-related groups (DRG) system? METHODS A retrospective analysis was carried out of data for 571 patients who underwent total laparoscopic hysterectomy (TLH) in the Department of Gynecology at the University of Erlangen from 2009 to 2012, with/without adnexectomy, due to benign indication; and of data for 255 patients who underwent the same procedures in Karlsruhe Municipal Hospital in 2013-2014. The patients were classified into two groups: those in whom surgery was carried out by experienced specialists who had carried out at least 40 independent operations; and those in whom it was carried out by a trainee resident who had personally done fewer than 40 operations. RESULTS In the two groups, the patients had similar mean body mass indexes, uterus weights, and blood losses. Patients in the specialist group were slightly older. There were no differences in complication rates. Over two-thirds of complications occurred in patients with previous surgery. Procedures by residents took significantly longer. Hospitalization periods in both groups were still below the mean threshold length of stay under Germany's DRG system, so that no income losses occurred even with training procedures. CONCLUSIONS Training and teaching operations supervised by experienced surgeons are just as safe as operations by experienced surgeons themselves. Interpretation of these data is of course limited by the retrospective study design; patients treated by specialists tended to have more prior operations and were older, with a trend toward larger uteri. Surgical training, as the example of TLH in benign indication shows here, involves an additional time of approximately 10-20 min per operation. With regard to the revenue situation, the hospitalization periods in both groups were within the profit zone for the hospital concerned.
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Affiliation(s)
- Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91052, Erlangen, Germany.
| | - Seher Emir
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Alexander Boosz
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91052, Erlangen, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
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De Wilde RL. Comment on the New DGGG AWMF S3-Guideline on Hysterectomy, or a Plea for LAVH as the Gold Standard for Total Hysterectomy Procedures. Geburtshilfe Frauenheilkd 2016; 76:365-366. [PMID: 27134289 DOI: 10.1055/s-0035-1568167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- R L De Wilde
- Director of the Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Universitätsklinik für Gynäkologie, Pius-Hospital Oldenburg, Carl von Ossietzky Universität Oldenburg, Oldenburg
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Pölcher M, Hauptmann S, Fotopoulou C, Schmalfeldt B, Meinhold-Heerlein I, Mustea A, Runnebaum I, Sehouli J. Should Fallopian Tubes Be Removed During Hysterectomy Procedures? - A Statement by AGO Ovar. Geburtshilfe Frauenheilkd 2015; 75:339-341. [PMID: 26028692 DOI: 10.1055/s-0035-1545958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Pölcher
- Frauenklinik Taxisstraße, Rotkreuzklinikum München, Munich
| | - S Hauptmann
- Institut für Pathologie, Krankenhaus Düren, Düren
| | - C Fotopoulou
- West London Gynaecological Cancer Centre and Ovarian Cancer Action Research Centre Imperial College Healthcare Trust London, London
| | - B Schmalfeldt
- Frauenklinik des Klinikums rechts der Isar der Technischen Universität München, Munich
| | - I Meinhold-Heerlein
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum RWTH Aachen, Aachen
| | - A Mustea
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsmedizin Greifswald, Greifswald
| | - I Runnebaum
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena
| | - J Sehouli
- Benjamin Franklin Charité Comprehensive Cancer Center (CCCC) Charité/Universitätsmedizin Berlin Charité, Berlin
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Dietl J. The marketing effect. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:796; author reply 797-8. [PMID: 21124699 DOI: 10.3238/arztebl.2010.0796b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Steigerwald U. Patient welfare. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:796; author reply 797-8. [PMID: 21124700 DOI: 10.3238/arztebl.2010.0796a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nieder J. Six authors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:797; author reply 797-8. [PMID: 21124701 DOI: 10.3238/arztebl.2010.0797a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Denschlag D, Ulrich U, Emons G. The diagnosis and treatment of endometrial cancer: progress and controversies. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 108:571-7. [PMID: 21904591 DOI: 10.3238/arztebl.2011.0571] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/23/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endometrial carcinoma is the fourth most common type of cancer among women in Germany, with more than 11 000 newly diagnosed cases each year. The present lack of clarity about the optimal clinical management of these patients is due in part to inconsistencies in the scientific evidence and in part to recent modifications of the FIGO classification. In this article, the issues requiring clarification are presented and discussed. METHODS This article is based on a selective review of the pertinent literature, including evidence-based guidelines and recommendations. RESULTS AND CONCLUSION Current scientific evidence does not support the screening of asymptomatic women. On the other hand, women with postmenopausal and acyclic bleeding should undergo histopathological evaluation, particularly if they have risk factors for endometrial cancer. The current FIGO classification divides endometrial cancer into stages depending on the findings at surgery. On the basis of risk stratification (e.g., by tumor stage and histological differentiation grade), women who are judged to be at high risk (FIGO Stage IB and above, Grade 3) should undergo not just hysterectomy and adnexectomy, but also systematic pelvic and para-aortic lymphadenectomy. Risk stratification also determines whether adjuvant radiotherapy should be given. The additional or alternative administration of chemotherapy is a particular consideration for women at high risk, although the pertinent clinical trials to date have yielded conflicting evidence on this point.
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Affiliation(s)
- Dominik Denschlag
- Gynäkologie und Geburtshilfe, Hochtaunus-Kliniken Bad Homburg, D-61348 Bad Homburg, Germany.
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