Effect of surgeon's experience on complications from laparoscopic hysterectomy

Naveiro-Fuentes, Mariña; Rodríguez-Oliver, A.J.; Fernández-Parra, J.; González-Paredes, A.; Aguilar-Romero, T.; Mozas-Moreno, Juan

doi:10.1016/j.jogoh.2017.11.004

Cited by 27 publications

(17 citation statements)

References 27 publications

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“…Finally, the experience of the surgeon is an important risk factor to consider when assessing the probability of adverse effects. The retrospective study made by Naveiro-Fuentes et al 27 classified surgeons into 3 groups based on their experience in laparoscopic hysterectomies. They observed that when the experience increased, the risk of major complications decreased with an OR 0.28 (95% CI 0.10-0.85).…”

Section: Discussionmentioning

confidence: 99%

Palmer's test usefulness in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers

Brenner-Anidjar

Rojo-Novo

Frías-Sánchez

et al. 2020

J of Obstet and Gynaecol

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Aim Abdominal cavity access accounts for 50% of complications during laparoscopic surgery. Different safety maneuvers have been used to try to diminish these. Our study aims to establish the usefulness of Palmer's test in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers, when used in addition to the determination of intraabdominal pressure. Methods Prospective observational analytic multi‐centered cohort study with 370 patients undergoing gynecologic laparoscopy between July 2014 and November 2019, comparing the additional use of Palmer's test in 185 patients (Palmer‐Test‐Yes, PTY), with intraabdominal pressure determination alone in 185 patients (Palmer‐Test‐No, PTN). Results Intergroup homogeneity was described for the basic characteristics of both population samples, except for mean age and percentage of previous laparotomy. A total of 19 complications were recorded, 10 in PTY and 9 in PTN, with no significant differences (P = 0.814). No differences were found in the analysis of these complications, except for the rate of conversion to laparotomy, which occurred four times in the PTY group and none in PTN (P = 0.044). Furthermore, no differences were found once fixed for the history of previous laparotomy (P = 514.), nor for the percentage of successful access after the first attempt between both groups (P = 0.753). Conclusion Palmer's test, when used in addition to intraabdominal pressure determination, has not shown to be effective in preventing failed access to abdominal cavity or reducing complications associated with access maneuvers with the Veress needle. Hence, its systematic use is not justified, since it could generate a sense of false security.

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Section: Discussionmentioning

confidence: 99%

Palmer's test usefulness in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers

Brenner-Anidjar

Rojo-Novo

Frías-Sánchez

et al. 2020

J of Obstet and Gynaecol

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“…Irrespective of the procedure of choice, determining factors for the neurosurgeon's preference appeared to be "feeling comfortable" and "having experience". It is obvious that both go hand in hand [17][18][19], and it is logical that surgeons feel more comfortable with ACDF as the approach is part of the routine for other procedures as well. Also the exposure to the PCF technique during residency was minor in 61,2% of the respondents, which could contribute in feeling less comfortable with the PCF technique.…”

Section: Discussionmentioning

confidence: 99%

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands.

Broekema

Groen

Tegzess

et al. 2019

Preprint

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Background For cervical foraminal nerve root decompression, anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) can be applied. Amongst neurosurgeons, there seems to be a tendency to prefer ACDF over PCF, even though there are some advantages in favor of PCF. The object of present study is to evaluate which factors determine the choice for an anterior or posterior surgical approach in patients with a cervical radicular syndrome based on foraminal pathology. Methods A web-based survey was sent to all 133 neurosurgeons in the Netherlands. The first part focused on general perceived (dis)advantages of ACDF and PCF. The second part concerned questions about the choice between the two procedures. Furthermore, it was analyzed if exposure during training, amount of performed surgeries, assumed reoperation and complication rates influenced the choice of procedure by conducting Chi-square tests with post-hoc analysis. Results A total of 56 neurosurgeons responded (42%). Of these, 77% performed more than 10 ACDF and 25% more than 10 PCF annually. An overall preference for ACDF was observed, even when differentiating for a pure disc prolapse, a spondylotic or a combined stenosis. The most relative important factors for motivating the preference for either ACDF or PCF were: the assumed best decompression of the nerve root (18%), perceived congruence with current literature (16%), exposure during residency (12%), personal comfort with the procedure (11%), and experience with the technique (11%). Conclusions In this survey, there was an overall preference for ACDF above PCF for the surgical treatment of a foraminal cervical radiculopathy. In addition to subjective factors as “experience” and “ comfort” with the procedure, the respondents often motivated their choice as “the best one according to literature”. As there is currently no evidence about the superiority of any of the procedures in literature, this assumption is remarkable.

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“…Numerous analyses, across surgical procedures, have suggested that experience with a technique is correlated with decreased complication rates, and so the reduced complication rates seen among the Belgrade patients may well reflect high surgical volume rather than factors directly related to technique. 28,29 Additionally, as the Serbian authors also see a number of international patients, the follow-up time for individual patients may have been shorter than the total time reported in the studies, as some patients may have returned to their homes, thus reducing the rates of complications reported. As all of the reports were based on the experiences of single surgical teams, it was impossible to differentiate whether outcome differences were the result of the technique or the skills and experience of the involved surgeons.…”

Section: Limitationsmentioning

confidence: 99%

Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

Jolly

Boskey

et al. 2021

Sexual Medicine

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Introduction: There has been an exponential increase in referrals for transmasculine patients seeking genital affirmation surgery. Despite transgender men's equal interest in metoidioplasty and phalloplasty, research has primarily focused on phalloplasty. Aim: To summarize and investigate the relationship between surgical technique, complications, and patientsatisfaction. Methods: We performed a systematic review and meta-analysis of surgical techniques and physician-and patient-reported outcomes of gender-affirming clitoral release and metoidioplasty (PROSPERO# 158722) with literature from PubMed, Google Scholar, and ScienceDirect. Data were extracted using PRISMA guidelines. All searches, extractions, and grading were independently completed by 2 authors. Main Outcome Measures: Main measures were surgical technique, patient satisfaction, voiding, urethral stricture, and urethral fistula. Results and Conclusion: A total of 7 non-overlapping articles on metoidioplasty were identified, with a total of 403 patients. We identified 4 metoidioplasty techniques: Hage, Belgrade, labial ring flap, and extensive metoidioplasty. All techniques included urethral lengthening. The reported neophallus length ranged from 2 cm to 12 cm, with the smallest neophallus occurring with the labial ring flap technique and extensive metoidioplasty the largest. Across techniques, voiding while standing was reported in most patients, with the lowest rate reported with the labial ring flap (67%). Complications were impacted by surgical technique, with the lowest rates of fistula and stricture occurring with the Belgrade technique. Fistula rates ranged from 5% to 37%, while stricture ranged from 2% to 35% of patients. The Belgrade technique reported significantly lower rates of fistula and stricture (P ¼ .000). The patient-reported outcomes were described for the Belgrade technique and extensive metoidioplasty. Both techniques showed high aesthetic and sexual satisfaction. Transgender individuals can achieve an aesthetically and sexually satisfactory neophallus using a variety of metoidioplasty techniques; however, urethral outcomes vary significantly by technique. The Belgrade technique reported the best outcomes, although data remains limited. Patient priorities should be used to determine surgical technique. D Jolly, CA Wu, ER Boskey, et al. Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes. Sex Med 2020;XX:XXXeXXX.

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Effect of surgeon's experience on complications from laparoscopic hysterectomy

Cited by 27 publications

References 27 publications

Palmer's test usefulness in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers

Palmer's test usefulness in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands.

Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

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