BackgroundTo inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. MethodsWe identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). ResultsA total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). ConclusionsOverall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to
Laparoscopic surgery in gynaecology is mainstream and widely practised. While this brings many benefits to the patient, injury to the surgeon is often under-reported. Careful theatre layout and correct instruments minimise the risk to the surgeon. There is a lack of gynaecology-specific guidelines/training in optimal theatre layout and surgeon positioning. This article examines the current available evidence and suggests changes that clinicians can make in order to optimise their working environment. Learning objectivesTo appreciate the many ways the operating theatre can be changed to facilitate optimal ergonomics. To be aware of the different equipment available to facilitate comfort when operating. To recognise the short-term and long-term repercussions of poor ergonomics. Ethical issuesShould this form part of every surgeon's training? Despite obvious benefits for patients, should employers pay closer attention to the health of their staff?
Although it is clear that laparoscopic surgery is beneficial to the patient, such surgery brings with it unique challenges and possible injury to the surgeon. Firstly, we sought to investigate the prevalence of musculoskeletal distress experienced by trainees. Secondly, we sought to ascertain if the trainees had received appropriate instruction to optimise their operative environment during laparoscopic surgery. An anonymised questionnaire survey was distributed to all 89 trainees in obstetrics and gynaecology within Northern Ireland. Forty-four (83 %) trainees reported to having received formal instruction in theatre layout and operating body position. However, only 8 (15 %) were aware of the ideal operating surface height, and 6 (11 %) knew the ideal monitor position, while 11 (20 %) and 7 (13 %) knew the correct angles for grasping and suturing tissue, respectively. Eightyfive percent of trainees suffered some form of musculoskeletal distress with back, shoulder and neck pain the most common areas affected. Eyestrain was reported by 1/3 of trainees. Although no trainees required sick leave, one in three required regular analgesia, physiotherapy or alternative therapies. It is clear that current training has not addressed operating ergonomics sufficiently, and this is having a significant impact on trainees' health.
Surgical smoke is generated by energy-based surgical instruments, and all staff and patients are potentially exposed to it in the operating theatre environment. The components of surgical smoke include water and chemicals, with potential bacterial and viral transmission also described. Surgical smoke inhalation has been associated with respiratory tract symptoms, as well as possible infective and carcinogenic risk. Existing guidance recommends appropriate personal protection and adequate ventilation as best practice against this occupational hazard. Learning objectivesTo identify the sources and components of surgical smoke.To raise awareness of the potential health risks associated with surgical smoke exposure. To educate in risk-reducing strategies and practices. Ethical issuesPractitioners need to be made aware of the health risks associated with surgical smoke. Employers have a health and safety duty to provide safe systems of work. Occupational health hazards and their prevention should be a component of formal training.
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