Factors influencing women’s decision making in hysterectomy

Janda, Monika; Armfield, Nigel R; Page, Katie; Kerr, Gayle; Kurz, Suzanne; Jackson, Graeme; Currie, Jason; Weaver, Edward; Yazdani, Anusch; Obermair, Andreas

doi:10.1016/j.pec.2017.09.006

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…Previous studies examined the relationships between surgical approach to hysterectomy and women’s quality of life, for both benign and oncologic conditions ( 14 – 19 ). Most studies compared laparoscopic and open abdominal surgery ( 9 – 13 ), while 1 study compared TLH, VH, and TAH ( 8 ), and 4 TLH versus RH, reviewed in Albright et al ( 20 ). These studies all concluded that minimally invasive surgical approaches were associated with better postoperative quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…Among 285 Australian obstetrics and gynecology specialists, the dominating barrier to practicing less invasive surgery was a lack of surgical training and mentoring (9). Among women who had a hysterectomy in the previous 2 years, the majority (62%) followed their doctor's advice on the surgical approach, and very few (<15%) sought a second opinion (10).…”

Section: Introductionmentioning

confidence: 99%

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Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women

Janda

Armfield

Kerr

et al. 2019

Journal of Patient Experience

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Objective: To evaluate women’s experiences after hysterectomy and predictors of their contentment and regret with the surgical approaches. Methods: Cross-sectional, Patient-Reported Experience Measures survey in 2319 Australian women aged 21 to 90 years (median age of 52 years) who had received hysterectomy in the preceding 2 years. Results: Overall, the vast majority of women (>96%) did not regret having had the hysterectomy. Women who received an open abdominal hysterectomy reported slower recovery with about 7% of women still not fully recovered after 12 months compared to those whose surgery was through a less invasive approach. Women who reported no adverse events, having been given a choice of type of hysterectomy, women who received an alternative to open abdominal hysterectomy, and women who felt prepared for discharge from hospital were significantly more likely to be content with their hysterectomy and report positive patient experiences. Conclusions: Compared with those who received a less invasive approach to hysterectomy, women who received open surgery were more likely to express negative experiences relating to their hospital stay and recovery from surgery. The results inform future improvements of care for women planning a hysterectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women

Janda

Armfield

Kerr

et al. 2019

Journal of Patient Experience

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“…This is particularly likely to affect surgeons in smaller, rural hospitals where a lack of training opportunities will limit the number of surgeons performing MAS procedures 5. Low numbers of patients requesting MAS may also limit uptake, either because patients are unaware of MAS or that the technique is associated with improved outcomes 5 9…”

Section: Introductionmentioning

confidence: 99%

Using end-user feedback to optimize the design of the Versius Surgical System, a new robot-assisted device for use in minimal access surgery

Hares

Roberts

Marshall

et al. 2019

BMJ Surg Interv Health Technologies

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BackgroundRobot-assisted minimal access surgery (MAS) reduces blood loss, recovery time, intraoperative and postoperative complications and pain. However, uptake of robotic MAS remains low, suggesting there are barriers to its use. To overcome these barriers, a new surgical robot system, Versius, was developed based on the needs and feedback of surgeons and surgical teams.MethodsThe surgical robot prototype was designed based on observations in the operating room (OR) and previous interviews with surgeons. Formative studies with surgeons and surgical teams were used to refine the prototype design, resulting in modifications to all components, including the arms, instruments, handgrips and surgeon console. Proof-of-concept cadaver studies were used to further optimize its design by assessing its usability during surgical procedures.ResultsFeedback led to the development of a novel, mobile design with independent arm carts and surgical console, linked by supported serial or parallel connections, providing maximum flexibility in the OR. Instrument tips were developed based on surgeons’ preferred designs and wristed at the tip providing seven degrees of freedom within the patient. Multiple handgrip designs were assessed by surgeons; of these, a ‘game controller’ design was rated most popular and usable. An open surgical console design allowing multiple working positions was rated highest by surgeons and the surgical teams.ConclusionsThis surgical robot system has been developed using feedback from end users throughout the design process and aims to minimize barriers to robotic MAS uptake. Additionally, these studies demonstrate system success in the surgical procedures it was designed for. The studies reported here, and further studies of the Versius Surgical System, are intended to align with IDEAL (Idea, Development, Exploration, Assessment, Long-term study) Framework guidance.

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“…To investigate why TAH was still commonly used, a survey of Australian and New Zealand gynaecologists identified two main barriers impeding the uptake of TLH: (1) surgeons’ lack of procedural skills for TLH and (2) the limited availability of structured training and mentoring opportunities to assist practising surgeons to gain those skills 27. Women who have had a hysterectomy were surveyed and reported that they commonly follow the advice of their doctor with regards to the type of hysterectomy, and rarely reported to seek a second opinion 28…”

Section: Rationalementioning

confidence: 99%

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

Obermair

Armfield

Graves³

et al. 2019

BMJ Open

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IntroductionHysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH).Methods and analysisStepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals.Primary outcomesChange in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention; we aim to reduce TAH by at least 30% in 75% of the trainees.Secondary outcomes(1) Number of hospitals screened, eligible, agree to training and complete the training; (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency; (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure; change in proportion proficient over time; (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay >7 days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection); (5) hospital length-of-stay; (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH.Ethics and disseminationThe study has been approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03617354; Pre-results.

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Factors influencing women’s decision making in hysterectomy

Abstract: Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future.

Cited by 7 publications

References 17 publications

Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women

Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women

Using end-user feedback to optimize the design of the Versius Surgical System, a new robot-assisted device for use in minimal access surgery

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

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