The Impact of Systematic Laparoscopic Skills and Suture Training on Laparoscopic Hysterectomy Outcomes in a Brazilian Teaching Hospital.

Autor: Lobão Gonçalves AL; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil., Ayroza-Ribeiro HA; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil., Lima RF; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil., Yonamine AEE; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil., Ohara F; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil., Ayroza-Ribeiro PAG; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia [Rev Bras Ginecol Obstet] 2019 Dec; Vol. 41 (12), pp. 718-725. Date of Electronic Publication: 2019 Dec 19.
DOI: 10.1055/s-0039-1700587
Abstrakt: Objective:  To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital.
Methods:  A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program.
Results:  A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 ( p  = 0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 ( p  = 0.010). Although we observed decreased uterine volume (154.2 cm 3 ) in group I-2 compared to group I-1 (217.8 cm 3 ) ( p  = 0.030), logistic regression did not find any association between uterine volume and surgical time ( p  = 0.103).
Conclusion:  The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.
Competing Interests: The authors have none to disclose.
(Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)
Databáze: MEDLINE