The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study.

STUDY OBJECTIVE

To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GOs), or general obstetrician/gynecologists (OB/GYNs).

DESIGN

Retrospective cohort study.

SETTING

Quaternary care academic hospital.

PATIENTS

Patients undergoing MIH for benign indications from March 2015 to March 2020 were included.

INTERVENTIONS

MIH.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons' group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.36-3.71), and 25.9% of the OB/GYN group (OR, 2.65; 95% CI, 1.70-4.12). Major intra- or postoperative complications were associated with surgeons' groups (OR, 7.02; 95% CI, 2.67-18.47, and OR, 6.84; 95% CI, 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%; OR, 7.21; 95% CI, 2.52-20.60) and OB/GYNs (9.7%; OR, 7.82; 95% CI, 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs than MIGS (18.5% vs 10.9%; OR, 1.86; 95% CI, 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared with GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs than MIGS surgeons (OR, 2.12; 95% CI, 1.07-4.22; OR, 2.48; 95% CI, 1.49-4.12, respectively).

CONCLUSION

Fellowship-trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.