Clark Nisse V, Gujral Harneet S, Wright Kelly N
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
JSLS. 2017 Jul-Sep;21(3). doi: 10.4293/JSLS.2017.00037.
As the performance of minimally invasive hysterectomy has increased in the United States, the need to apply outcomes measures has also increased. This study was conducted to determine the impact of a fellowship-trained minimally invasive gynecologic surgery (MIGS) specialist on patient outcomes after laparoscopic hysterectomy (LH) in a gynecology department.
This is a retrospective review of 218 patients who underwent a laparoscopic hysterectomy for benign indications at a suburban academic-affiliated tertiary care hospital with a broad patient base from 2010 to 2014.
A total of 218 women underwent conventional laparoscopic hysterectomy by 10 members of a gynecology department: 96 women (44%) by a MIGS specialist and 122 women (56%) by a group of general gynecologists. Operative time was less (119 vs 148 min; < .001), and patients were more likely to be discharged on the same day (90.6% vs 66.4%; < .001) for the MIGS specialist compared to other surgeons. More patients of the MIGS specialist had undergone prior laparotomies (42.7% vs 17.2%; = < .001) and had a greater uterine weight (392 vs 224 g; < .001). Although the difference was not statistically significant, conversion to laparotomy (0 vs 2 cases; = .505) and postoperative infection (6 vs 16 cases; = .095) were lower for the MIGS specialist. Total billing charges were also lower for the MIGS specialist ($9,920 vs $11,406; < .001).
A fellowship-trained MIGS specialist performed laparoscopic hysterectomy in less time on more difficult surgical patients, with a shorter length of stay and lower costs, and no difference in complications compared to other providers in a gynecology department.
随着美国微创子宫切除术的开展增多，应用疗效指标的需求也在增加。本研究旨在确定接受过专科培训的微创妇科手术（MIGS）专家对妇科腹腔镜子宫切除术（LH）患者术后结局的影响。
这是一项对218例患者的回顾性研究，这些患者于2010年至2014年在一家拥有广泛患者群体的郊区学术附属三级护理医院因良性指征接受了腹腔镜子宫切除术。
妇科的10名医生共为218名女性实施了传统腹腔镜子宫切除术：96名女性（44%）由MIGS专家实施，122名女性（56%）由一组普通妇科医生实施。与其他外科医生相比，MIGS专家的手术时间更短（119分钟对148分钟；P<0.001），患者更有可能在同一天出院（90.6%对66.4%；P<0.001）。MIGS专家的更多患者曾接受过剖腹手术（42.7%对17.2%；P<0.001）且子宫重量更大（392克对224克；P<0.001）。尽管差异无统计学意义，但MIGS专家的中转开腹率（0例对2例；P = 0.505）和术后感染率（6例对16例；P = 0.095）更低。MIGS专家的总计费费用也更低（9920美元对11406美元；P<0.001）。
与妇科的其他医生相比，接受过专科培训的MIGS专家在更复杂的手术患者身上实施腹腔镜子宫切除术的时间更短，住院时间更短，费用更低，且并发症无差异。
