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. 2018 Jun;297(6):1517-1523.
doi: 10.1007/s00404-018-4761-1. Epub 2018 Mar 30.

Influence of training level on cervical cone size and resection margin status at conization: a retrospective study

Eliana Montanari  1 , Christoph Grimm  1 , Richard Schwameis  1 , Lorenz Kuessel  1 , Stephan Polterauer  1 , Chiara Paternostro  2 , Heinrich Husslein  3
Affiliations

Influence of training level on cervical cone size and resection margin status at conization: a retrospective study

Eliana Montanari et al. Arch Gynecol Obstet. 2018 Jun.

Abstract

Objective: To explore whether a surgeon's training level influences the rate of incomplete resections or the amount of resected cervical tissue in women treated with large loop excision of the transformation zone (LLETZ).

Methods: The present study is a retrospective analysis of the data of women who had undergone LLETZ for cervical intraepithelial neoplasia (CIN) within the years 2004-2008 at the Medical University of Vienna. Women were grouped according to the level of training of the operating surgeon (i.e, resident or staff gynecologist) and univariate and multivariable analyses were performed to identify independent risk factors for excessive cone volume, depth and incomplete resection (i.e., positive resection margin).

Results: Data of 912 women were analysed. Residents had a significantly larger cone volume [median 2681 (interquartile range 1472-4109) mm3] than staff gynecologists [2094 (1309-3402) mm3] (p = 0.001) in univariate analysis. The depth of resection and the rate of incomplete resection were comparable between both groups. In a binary logistic multivariable analysis, the level of training as well as patient's age was significantly associated with a cone volume larger than 2500 mm3.

Conclusion: Conization performed by residents as opposed to staff gynecologists does not compromise the procedure's effectiveness but may expose women to a potential additional risk for adverse obstetrical outcomes due to excessive resection of cervical tissue.

Keywords: CIN; Cervical conization; Incomplete resection; LLETZ; Surgical training.

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Conflict of interest statement

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Medical University of Vienna (EK number 1712/2015, approved September 2015). According to the University Ethics Committee a formal consent was not required for this type of study, and therefore, the need for informed consent for participation was waived.

Human/animal rights statement

This article does not contain any studies with animals performed by any of the authors.

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