Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School, Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal.
University of Witten Herdecke, Witten, Germany; Clinic for Gynecology and Obstetrics, Rheinland Clinics, Dormagen, Germany.
Eur J Obstet Gynecol Reprod Biol. 2023 Dec;291:99-105. doi: 10.1016/j.ejogrb.2023.10.016. Epub 2023 Oct 15.
This study aimed to explore the current opinion on the routes of hysterectomy amongst the members of the International Society for Gynaecologic Endoscopy (ISGE), as well as the perceptions of potential barriers that inhibit gynaecologists from offering a minimally invasive hysterectomies (MIHs) to their patients.
An anonymous, electronic survey was designed, including the questions about the surgeon location and length of gynaecological practice, preferred approach to hysterectomy, approximate number of surgical cases performed during the year preceding the survey (2021), and potential barriers and contraindications to performing MIHs. It was validated by 12 practicing gynaecologists. Subsequently, the survey was sent to all practicing gynaecologists who are the members of the ISGE.
We received a response from 159 members of ISGE (29 % response rate), of which 92 % with ≥ 5 years in practice since the completion of their residency training in Gynaecology and Obstetrics. When asked about the preferred route of hysterectomy for themselves or their relatives, 59 % chose total laparoscopic hysterectomy (TLH), 19 % vaginal hysterectomy (VH), 8 % chose laparoscopically-assisted vaginal hysterectomy (LAVH) and 5 % chose total abdominal hysterectomy (TAH). However, TAH was the most performed hysterectomy procedure undertaken by the respondents in the year preceding the survey. When asked about the main obstacles to performing MIHs, more than half of the respondents highlighted insufficient training during residency and insufficient surgical experience. Only 25 % of the responders acknowledged reading the ISGE guidelines on performing vaginal hysterectomy.
Contrary to a full understanding of the benefits of MIHs, lack of training, as well as insufficient surgical experience and unawareness of existing evidence-based guidelines were the main reasons for the high rate of TAH among the ISGE members who participated in the study. All efforts should be directed at teaching VH and TLH techniques during residency, continuous acquisition of practical experience, and use of validated patient selection guidelines for MIH in daily clinical practice.
本研究旨在探讨国际妇科内镜学会（ISGE）成员对子宫切除术途径的当前看法，以及阻碍妇科医生为患者提供微创子宫切除术（MIH）的潜在障碍的看法。
设计了一项匿名电子调查，其中包括有关手术医生位置和妇科实践年限、首选的子宫切除术方法、调查前一年（2021 年）进行的手术病例数、以及进行 MIH 的潜在障碍和禁忌症的问题。该调查由 12 名从事妇科工作的医生进行了验证。随后，向所有符合条件的 ISGE 成员发送了该调查。
我们收到了 159 名 ISGE 成员的回复（29%的回复率），其中 92%的成员在完成妇科和产科住院医师培训后至少有 5 年的实践经验。当被问及他们自己或亲属首选的子宫切除术途径时，59%的人选择了全腹腔镜子宫切除术（TLH），19%的人选择了阴道子宫切除术（VH），8%的人选择了腹腔镜辅助阴道子宫切除术（LAVH），5%的人选择了全腹部子宫切除术（TAH）。然而，在调查前一年，TAH 是受访者进行的最常见的子宫切除术。当被问及进行 MIH 的主要障碍时，超过一半的受访者强调住院医师培训期间的培训不足以及手术经验不足。只有 25%的应答者承认阅读了 ISGE 关于进行阴道子宫切除术的指南。
尽管充分了解 MIH 的益处，但缺乏培训以及手术经验不足和对现有循证指南的认识不足是参与研究的 ISGE 成员中 TAH 发生率高的主要原因。应努力在住院医师培训期间教授 VH 和 TLH 技术，不断获得实践经验，并在日常临床实践中使用经过验证的 MIH 患者选择指南。
