Pijnenborg Johanna M A, ter Haar Johanne F
Department of Obstetrics and Gynecology, TweeSteden Hospital, Tilburg, The Netherlands.
J Laparoendosc Adv Surg Tech A. 2011 Sep;21(7):615-9. doi: 10.1089/lap.2010.0443. Epub 2011 May 25.
Laparoscopic hysterectomy (LH) is poorly adopted by general gynecologists. The aim of this study was to assess the differences between residents, general gynecologists, and laparoscopic-orientated gynecologists in the choice of surgical route in patients planned for hysterectomy.
An observational study was carried out at a teaching hospital in south of The Netherlands. All patients who were planned for a hysterectomy for benign or premalignant indications between January 2005 and April 2009 were included. All performed hysterectomies were evaluated for the planned surgical route: vaginal, abdominal, or LH. Surgeons were divided into three categories: residents, general gynecologists, and laparoscopic-orientated gynecologists.
One hundred thirty-nine (35.8%) patients were planned for a vaginal approach, 151 (38.9%) for an abdominal approach, and 98 (25.2%) for a laparoscopic approach. The percentage of planned vaginal hysterectomies was comparable for all surgeons. There was a significant difference between the percentage of planned LHs by residents (30%) and that by general gynecologists (6%). As expected, laparoscopic-orientated gynecologists planned a laparoscopic approach in 53% of their cases.
LH as alternative to abdominal hysterectomy is rarely planned by general gynecologists. Residents could play a role in the implementation of LH.
普通妇科医生对腹腔镜子宫切除术（LH）的接受程度较低。本研究的目的是评估住院医师、普通妇科医生和以腹腔镜手术为主的妇科医生在计划进行子宫切除术的患者手术途径选择上的差异。
在荷兰南部的一家教学医院进行了一项观察性研究。纳入了2005年1月至2009年4月期间因良性或癌前病变而计划进行子宫切除术的所有患者。对所有实施的子宫切除术的计划手术途径进行评估：经阴道、经腹或腹腔镜手术。外科医生分为三类：住院医师、普通妇科医生和以腹腔镜手术为主的妇科医生。
139例（35.8%）患者计划采用经阴道途径，151例（38.9%）计划采用经腹途径，98例（25.2%）计划采用腹腔镜途径。所有外科医生计划经阴道子宫切除术的比例相当。住院医师计划进行腹腔镜子宫切除术的比例（30%）与普通妇科医生（6%）之间存在显著差异。正如预期的那样，以腹腔镜手术为主的妇科医生在53%的病例中计划采用腹腔镜途径。
普通妇科医生很少将腹腔镜子宫切除术作为腹式子宫切除术的替代方案。住院医师在腹腔镜子宫切除术的实施中可以发挥作用。
