Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Surg Endosc. 2018 Feb;32(2):1021-1026. doi: 10.1007/s00464-017-5780-x. Epub 2017 Aug 25.
A multicenter, retrospective, cohort study was conducted in the Netherlands. The aim was to evaluate whether surgical volume of laparoscopic hysterectomies (LHs) performed by proven skilled gynecologists had an impact on the conversion rate from laparoscopy to laparotomy.
In 14 hospitals, all LHs performed by 19 proven skilled gynecologists between 2007 and 2010 were included in the analysis. Surgical volume, conversion rate and type of conversion (reactive or strategic) were retrospectively assessed. To estimate the impact of surgical volume on the conversion rate, logistic regressions were performed. These regressions were adjusted for patient's age, Body Mass Index (BMI), ASA classification, previous abdominal surgery and the indication (malignant versus benign) for the LH.
During the study period, 19 proven skilled gynecologists performed a total of 1051 LHs. Forty percent of the gynecologists performed over 20 LHs per year (median 17.3, range 5.4-49.5). Conversion to laparotomy occurred in 5.0% of all LHs (53 of 1051); 38 (3.6%) were strategic and 15 (1.4%) were reactive conversions. Performing over 20 LHs per year was significantly associated with a lower overall conversion rate (OR 0.43, 95% CI 0.24-0.77), a lower strategic conversion rate (OR 0.32, 95% CI 0.16-0.65), but not with a lower reactive conversion rate (OR 0.96, 95% CI 0.33-2.79).
A higher annual surgical volume of LHs by proven skilled gynecologists is inversely related to the conversion rate to laparotomy, and results in a lower strategic conversion rate.
一项多中心、回顾性、队列研究在荷兰进行。目的是评估由经验丰富的妇科医生进行的腹腔镜子宫切除术（LH）的手术量是否会影响腹腔镜到剖腹手术的转化率。
在 14 家医院中，分析了 2007 年至 2010 年间由 19 名经验丰富的妇科医生进行的所有 LH。回顾性评估手术量、转化率和转换类型（反应性或策略性）。为了估计手术量对转化率的影响，进行了逻辑回归。这些回归调整了患者的年龄、体重指数（BMI）、ASA 分类、先前的腹部手术以及 LH 的适应证（恶性与良性）。
在研究期间，19 名经验丰富的妇科医生共进行了 1051 例 LH。40%的妇科医生每年进行超过 20 例 LH（中位数为 17.3，范围为 5.4-49.5）。所有 LH 中有 5.0%（53/1051）转为剖腹手术；38 例（3.6%）为策略性转换，15 例（1.4%）为反应性转换。每年进行超过 20 例 LH 与整体转化率较低显著相关（OR 0.43，95%CI 0.24-0.77），策略性转化率较低（OR 0.32，95%CI 0.16-0.65），但与反应性转化率较低无关（OR 0.96，95%CI 0.33-2.79）。
由经验丰富的妇科医生进行的 LH 每年手术量较高与转化为剖腹手术的比率呈反比，并且导致策略性转化比率降低。
