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

Introduction: The implementation of advanced minimally invasive surgical (MIS) techniques has broadened. An extensive body of literature shows that high hospital and surgeon volumes lead to better patient outcomes. However, no information is available regarding volume trends in the post-implementation phase of MIS. This study investigated...

Incidence and groups at risk for unexpected uterine leiomyosarcoma: a Dutch nationwide cohort study

Objective: To estimate the risk of uterine leiomyosarcoma in patients undergoing gynecological surgery and also to identify groups at risk for unrecognized uterine leiomyosarcoma. Methods: A national cohort study was performed evaluating all uterine leiomyosarcoma (ULMS) diagnosed in The Netherlands between January 2000 and September 2015....

Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: A randomised controlled trial

Objective: To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR). Study design: Non-inferiority randomised controlled trial. Population: Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. Methods: Women were...

Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: A cohort analysis to define a case-mix variable

Background: Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if...

Urinary catheterisation management after laparoscopic hysterectomy: a national overview and a nurse preference survey

The aim of this study was to evaluate the catheterisation regimes after a laparoscopic hysterectomy (LH) in Dutch hospitals and to assess the nurses’ opinion on this topic. This was particularly relevant as no consensus exists on the best moment to remove a urinary catheter after an LH. All 89 Dutch hospitals were successfully contacted and...

Towards spill-free in-bag morcellation: a health failure mode and effects analysis

Background: To assess potential risks of new surgical procedures and devices before their introduction into daily practice, a prospective risk inventory (PRI) is a required step. This study assesses the applicability of the Health Failure Mode and Effects Analysis (HFMEA) as part of a PRI of new technology in minimally invasive gynecologic...

Surgical phase modelling in minimal invasive surgery

Background: Surgical Process Modelling (SPM) offers the possibility to automatically gain insight in the surgical workflow, with the potential to improve OR logistics and surgical care. Most studies have focussed on phase recognition modelling of the laparoscopic cholecystectomy, because of its standard and frequent execution. To demonstrate...

Intra-operative estimation of surgical progress

Driven by rising health care costs due to factors including advancing technology and an aging population, cost-effectiveness has become an increasingly important aspect of care delivery, with the operating room (OR) being a specific area of interest. By means of a surgical process model (SPM), OR systems can gain an understanding of clinical...

Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis

Purpose: To assess the safety and effectiveness of LESS compared to conventional hysterectomy. Methods: The systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort...

Laparoscopic hysterectomy for benign indications: clinical practice guideline

Purpose: Since the introduction of minimally invasive gynecologic surgery, the percentage of advanced laparoscopic procedures has greatly increased worldwide. It seems therefore, timely to standardize laparoscopic gynecologic care according to the principles of evidence-based medicine. With this goal in mind—the Dutch Society of Gynecological...

Identification of risk factors in minimally invasive surgery: a prospective multicenter study

Background: Since the introduction of minimally invasive surgery (MIS), concerns for patient safety are more often brought to the attention. Knowledge about and awareness of patient safety risk factors are crucial in order to improve and enhance the surgical team, the environment, and finally surgical performance. The aim of this study was to...

Hospital versus individual surgeon’s performance in laparoscopic hysterectomy

Purpose: To compare hospital versus individual surgeon’s perioperative outcomes for laparoscopic hysterectomy (LH), and to assess the relationship between surgeon experience and perioperative outcomes. Methods: A retrospective analysis of all prospective collected LHs performed from 2003 to 2010 at one medical center was performed....

A new approach to simplify surgical colpotomy in laparoscopic hysterectomy

New surgical techniques and technology have simplified laparoscopic hysterectomy and have enhanced the safety of this procedure. However, the surgical colpotomy step has not been addressed. This study evaluates the surgical colpotomy step in laparoscopic hysterectomy with respect to difficulty and duration. Furthermore, it proposes an...

Efficacy and safety of uterine manipulators in laparoscopic surgery: A review

Purpose This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. Methods PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Premier, Science Direct and the MAUDE database were...

Design process of a trans-vaginal morcellator for total laparoscopic hysterectomy; from clinical functionality assessment to first prototype