Liu Grace, Zolis Lynne, Kung Rose, Melchior Mary, Singh Sukhbir, Francis Cook E
Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON.
St. Joseph's Health Sciences Centre, Toronto ON.
J Obstet Gynaecol Can. 2010 Feb;32(2):139-148. doi: 10.1016/S1701-2163(16)34428-0.
To survey all gynaecologists in Canada to determine the number who perform or offer the laparoscopic myomectomy (LM) procedure, the barriers that deter gynaecologists from performing or offering LM, and to understand the perceptions and attitudes of Canadian gynaecologists with respect to LM.
A survey was developed, pre-tested, and distributed to all 1279 obstetrician-gynaecologists on the SOGC mailing list in April 2007.
A total of 529 obstetrician-gynaecologists participated in the survey a response rate of 41.4%. Of the 485 respondents who practised gynaecology, 119 (24.5%) performed LM, but only 15 (3.1%) stated that more than 50% of their myomectomies were performed laparoscopically. Two hundred twelve gynaecologists (44.3%) admitted to having referred a patient to another gynaecologist for LM. Laparoscopic surgeons felt the principal barrier to performing LM was lack of training in the procedure (70.7%). Gynaecologists felt the principal barrier to referring to another gynaecologist for LM was their uncertainty about who offered the procedure (33%). The majority of gynaecologists believed that LM has faster recovery time. The majority of respondents, however, were unsure which procedure is superior with respect to blood loss, adhesion formation, fertility rate post-procedure, uterine rupture rate in subsequent pregnancy, and cost-effectiveness.
Despite existing evidence that indicates that LM is comparable to abdominal myomectomy with respect to complication rates and fertility, only one quarter of Canadian gynaecologists who responded to this survey performed the procedure. Barriers to performing LM included lack of training and barriers to referral included uncertainty about who offered the procedure.
对加拿大所有妇科医生进行调查，以确定实施或提供腹腔镜子宫肌瘤切除术（LM）的医生数量、阻碍妇科医生实施或提供LM的因素，并了解加拿大妇科医生对LM的看法和态度。
设计了一项调查问卷，进行预测试后，于2007年4月分发给加拿大妇产科医师协会邮件列表中的所有1279名妇产科医生。
共有529名妇产科医生参与了调查，回复率为41.4%。在485名从事妇科工作的受访者中，119名（24.5%）实施了LM，但只有15名（3.1%）表示其超过50%的子宫肌瘤切除术是通过腹腔镜进行的。212名妇科医生（44.3%）承认曾将患者转诊给其他妇科医生进行LM。腹腔镜外科医生认为实施LM的主要障碍是缺乏该手术的培训（70.7%）。妇科医生认为将患者转诊给其他妇科医生进行LM的主要障碍是他们不确定谁能实施该手术（33%）。大多数妇科医生认为LM的恢复时间更快。然而，大多数受访者不确定在失血、粘连形成、术后生育率、后续妊娠子宫破裂率以及成本效益方面哪种手术更具优势。
尽管现有证据表明，在并发症发生率和生育率方面，LM与开腹子宫肌瘤切除术相当，但在本次调查中回复的加拿大妇科医生中，只有四分之一实施了该手术。实施LM的障碍包括缺乏培训，而转诊障碍包括不确定谁能实施该手术。
