Trends in the implementation of advanced minimally invasive gynecologic surgical procedures in the Netherlands

Abstract

Study objectives: To assess the implementation of advanced laparoscopic gynecologic surgical procedures, assess the number of gynecologists performing these procedures, and highlight the distribution of surgical approaches to hysterectomy.

Design: Observational multicenter study.

Design classification: Canadian Task Force classification II-2.

Setting: All hospitals in The Netherlands.

Sample: Minimally invasive surgical procedures performed in all 90 hospitals in the year 2012, and the number of gynecologists performing these procedures. Data were compared with national surveys conducted in 2002 and 2007.

Interventions: The number of advanced laparoscopic gynecologic procedures, the number of gynecologists performing these procedures, and the distribution of approaches to hysterectomy were collected through a Web-based questionnaire.

Measurements and main results: The response rate was 96% (86 of 90 hospitals). A total of 4979 advanced laparoscopic gynecologic procedures were performed in 2012 (mean per hospital, 58; median, 50.5; SD, 44.4), which is a significant increase over 2007 (95% CI, 30.3-46.5; p < .001). The proportion of laparoscopic hysterectomy increased from 3% in 2002 to 10% in 2007 and to 36% in 2012. The proportions of abdominal hysterectomy (68% in 2002, 54% in 2007, and 39% in 2012) and vaginal hysterectomy (29% in 2002, 36% in 2007, and 25% in 2012) decreased significantly. However, approximately 37% of gynecologists (n = 76) and 12% of hospitals (n = 9) performed fewer than 20 advanced laparoscopic procedures (level 3 and level 4) annually.

Conclusions: Implementation of advanced laparoscopic gynecologic procedures has accelerated tremendously in the last decade, owing mainly to the increased number of laparoscopic hysterectomies. A significant shift has occurred from abdominal and vaginal hysterectomies toward a laparoscopic approach. The vaginal hysterectomy should be brought back in focus, to prevent the deterioration of skills needed to perform this least invasive approach. Furthermore, the introduction of case volume as quality assessment is sure to have consequences for daily gynecologic surgical practice in The Netherlands.

Keywords: Gynecology; Hysterectomy; Implementation; Laparoscopy; Surgical volume.