Hysterectomy—Should all residents learn to perform it?

Rudnicki, Martin; Trappen, Philippe Van; Kesteren, Paul van

doi:10.1111/aogs.13507

Cited by 5 publications

(6 citation statements)

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“…Rudnicki et al described that as a result of the increasing popularity of various nonsurgical modalities and laparoscopic/robotic‐assisted hysterectomies, the number of hysterectomies that a trainee can perform has decreased. They ask “Do all trainees in obstetrics and gynecology still need to learn to perform hysterectomy?” In our opinion, yes , all trainees still need to learn to perform abdominal hysterectomy.…”

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Hysterectomy: All obstetrician‐gynecologists should learn to perform it

Matsubara

Takahashi

Takei

et al. 2019

Acta Obstet Gynecol Scand

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Hysterectomy: All obstetrician-gynecologists should learn to perform itSir, Rudnicki et al 1 described that as a result of the increasing popularity of various nonsurgical modalities and laparoscopic/robotic-assisted hysterectomies, the number of hysterectomies that a trainee can perform has decreased. They ask "Do all trainees in obstetrics and gynecology still need to learn to perform hysterectomy?" In our opinion, yes, all trainees still need to learn to perform abdominal hysterectomy.Obviously, in the near future, some specialists will receive more training in laparoscopic/robotic-assisted hysterectomy and will be unaccustomed to conventional abdominal hysterectomy. Such specialists may not be able to expeditiously manage catastrophic bleeding during a laparoscopic/robotic-assisted hysterectomy because laparoscopic hemostasis may be unsuccessful with vascular injuries, which require immediate laparotomy to achieve hemostasis. A lack of self-confidence and familiarity with abdominal hysterectomy may prevent or delay conversion to laparotomy.Experience with abdominal hysterectomy is mandatory for being able to perform cesarean hysterectomy, such as for placenta accreta spectrum (PAS) disorders. Differing from surgery in other fields, obstetric operations do not always proceed in a step-by-step manner. 2 Obstetricians must perform cesarean section (hop), cesarean hysterectomy (step), and, then, PAS-hysterectomy (super-jump). Our team established the "universally achievable" cesarean/PAS-hysterectomy. 3 Obstetricians can accomplish this if they can perform a standard abdominal hysterectomy. 3,4 These two operations are sometimes unexpectedly required. It is difficult to predict who requires a cesarean hysterectomy, and PAS often goes undiagnosed preoperatively. Hence, we believe that every doctor dealing with deliveries should have experience in abdominal hysterectomy.We, the older generation of obstetricians and gynecologists, first learned abdominal hysterectomy and then began to perform laparoscopic/robotic-assisted hysterectomy. Thus, even if we encounter severe bleeding during laparoscopic/robotic-assisted hysterectomy, we immediately convert to laparotomy and stop the bleeding. Many are also capable of performing cesarean/PAS-hysterectomy because of abundant experience in abdominal hysterectomy.Rudnicki et al stated the concept that a reduced number of hysterectomies should be offered to trainees in "gynecologic" surgery specialties. The same concept was stated in the discussion of how to grow PAS-surgery specialists. 5 Widening these concepts, training different types of hysterectomies could be offered to selected ambitious/talented trainees, both in gynecologic and obstetric specialties. If such specialists are available 24/7, this may be effective.However, in many centers, this may not be the case.The number of abdominal hysterectomies performed will continue to decrease but trainees must learn this fundamental procedure. Until some definite solutions are found, we recommend: (a) simulation-training for ...

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Hysterectomy: All obstetrician‐gynecologists should learn to perform it

Matsubara

Takahashi

Takei

et al. 2019

Acta Obstet Gynecol Scand

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“…This assumption might encourage surgeons to perfect one hysterectomy approach, when possible, instead of aiming to master for example both the vaginal and laparoscopic approaches. Also, validated, standardized training programs are becoming more common, on‐line surgical videos and simulation can improve surgical skills 23–27 . Supplementary education of young doctors, in addition to hand‐to‐hand teaching from experienced doctors, might be valuable especially in small hospitals with few hysterectomies.…”

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confidence: 99%

“…Also, validated, standardized training programs are becoming more common, on‐line surgical videos and simulation can improve surgical skills. 23 , 24 , 25 , 26 , 27 Supplementary education of young doctors, in addition to hand‐to‐hand teaching from experienced doctors, might be valuable especially in small hospitals with few hysterectomies.…”

Section: Discussionmentioning

confidence: 99%

Ureteric injuries during hysterectomy—A Norwegian retrospective study of occurrence and claims for compensation over an 11‐year period

Ravlo

Moen

Bukholm³

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative conditions. Our aims were to evaluate and learn from compensation claims to The Norwegian System of Patient Injury Compensation (NPE) for ureteric injury occurring during hysterectomies to predict risk factors, time of identification, symptoms, and consequences, and to relate these cases to injuries registered in The Norwegian Patient Registry. Material and methods A retrospective study of ureteric injuries occurring during hysterectomies, reported to NPE and the Norwegian Patient Registry from 2009 through 2019. Results During the study period, 53 096 hysterectomies were registered in The Norwegian Patient Registry, of which ureteric injury was documented in 643 (1.2%). More ureteric injuries were registered in large hospital trusts than in small trusts (1.3% vs. 0.7%, p < 0.05). NPE received 69 claims due to ureteric injury occurring during hysterectomy, comprising 11% of all injuries in the study period. Compensation was approved for 15%. Women who claimed compensation were younger (48.1 ± 8.9 years vs. 55.1 ± 13.6 years, p < 0.01), more likely to have had a benign diagnosis (89.9% vs. 52.1%, p < 0.01), and more likely to have had the ureteric injury recognized after discharge (58.0% vs. 33.0%, p < 0.001) compared with non‐complainants. Identification of the ureters during the hysterectomy was documented in 30% of the NPE patient files. Additional information for the NPE cases included the following. The most common symptoms of unidentified injury were pain (77%), fever (12%), urinary leakage (13%), and anuria (8%). Re‐operation was necessary in 77% of the cases, and 10% of the women lost one kidney. Long‐term consequences after repair, such as loss of a kidney or persistent pain, were seen in 17%. No women died because of the injury. Conclusions The incidence of ureteric injury occurring during hysterectomy in Norway was 1.2%; 11% involved a claim for compensation, and 15% of these had their case approved. Most ureteric injuries were not recognized during the hysterectomy. Documentation of peroperative identification of the ureters during hysterectomy was often missing. Vigilance to pain as a postoperative symptom of peroperative unrecognized ureteric injury may result in earlier diagnosis and treatment.

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“…Dear Editors, The number of hysterectomies is decreasing. 1 Simulation training for hysterectomy may become one of possible solutions for decreasing number of hysterectomies allocated to each trainee. 2 However, 'doing the procedure itself' is indispensable for becoming an obstetrics-gynecology specialist.…”

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confidence: 99%