Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsMA (all authors).
Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsMA (all authors).
J Minim Invasive Gynecol. 2022 Sep;29(9):1099-1103. doi: 10.1016/j.jmig.2022.06.005. Epub 2022 Jun 9.
The objective of this case series is to evaluate the rates of ureteral injury at the time of laparoscopic hysterectomy among high-volume fellowship-trained surgeons.
A retrospective chart review was performed, evaluating laparoscopic hysterectomy cases between 2009 and 2019 performed exclusively by fellowship-trained surgeons.
Division of Minimally Invasive Gynecologic Surgery (MIGS) at the Brigham and Women's Hospital and Brigham and Women's Faulkner Hospital, a Harvard Medical School teaching hospital in Boston.
All patients undergoing laparoscopic hysterectomy by one of 5 surgeons with fellowship training in MIGS.
None.
A total of 5160 cases were handled by MIGS surgeons between 2009 and 2019 at our institution. Of these cases, 2345 were laparoscopic hysterectomy cases with available intraoperative and postoperative documentation. Most patients had undergone previous surgeries, and the most common indications for hysterectomy included uterine myomas, pelvic pain/endometriosis, and abnormal uterine bleeding. At the time of hysterectomy, 1 ureteral injury (0.04%) was noted. No additional delayed ureteral injuries were observed. Most patients were discharged home the same day (64.9%) and did not have any postoperative complications (63.9%) as designated by the Clavien-Dindo classification.
Ureteral injury, although rare, is more prevalent in gynecologic surgery than in other surgical disciplines that have some focus on the pelvis. No study to date has evaluated the effect of surgical training and volume on rates of ureteral injuries. This study retrospectively examined ureteral injury rates for one group of high-volume fellowship-trained surgeons and found their rates to be lower than the national average. Proposals are presented for optimizing training and delivery of gynecologic surgical care to minimize complications.
本病例系列旨在评估高年资专科培训外科医生行腹腔镜子宫切除术时输尿管损伤的发生率。
回顾性病历分析，评估 2009 年至 2019 年期间仅由专科培训外科医生行腹腔镜子宫切除术的病例。
波士顿哈佛医学院教学医院布莱根妇女医院和布莱根妇女法克纳医院微创妇科手术（MIGS）分部。
由 5 名具有 MIGS 专科培训的外科医生进行腹腔镜子宫切除术的所有患者。
无。
2009 年至 2019 年期间，MIGS 外科医生共处理了 5160 例病例，其中 2345 例为腹腔镜子宫切除术病例，有术中及术后记录。大多数患者之前都接受过手术，子宫切除术的最常见适应证包括子宫肌瘤、盆腔疼痛/子宫内膜异位症和异常子宫出血。在子宫切除术时，发现 1 例输尿管损伤（0.04%）。没有观察到其他迟发性输尿管损伤。大多数患者当天出院（64.9%），根据 Clavien-Dindo 分类，没有任何术后并发症（63.9%）。
输尿管损伤虽然罕见，但在妇科手术中比其他一些关注骨盆的外科手术更为常见。迄今为止，尚无研究评估手术培训和数量对输尿管损伤发生率的影响。本研究回顾性地检查了一组高年资专科培训外科医生的输尿管损伤发生率，发现其发生率低于全国平均水平。提出了优化妇科手术护理培训和实施的建议，以最大限度地减少并发症。
