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Innovations in surgery: the role of residents in the implementation of laparoscopic hysterectomy.

BACKGROUND
Laparoscopic hysterectomy (LH) is poorly adopted by general gynecologists. The aim of this study was to assess the differences between residents, general gynecologists, and laparoscopic-orientated gynecologists in the choice of surgical route in patients planned for hysterectomy.


METHODS
An observational study was carried out at a teaching hospital in south of The Netherlands. All patients who were planned for a hysterectomy for benign or premalignant indications between January 2005 and April 2009 were included. All performed hysterectomies were evaluated for the planned surgical route: vaginal, abdominal, or LH. Surgeons were divided into three categories: residents, general gynecologists, and laparoscopic-orientated gynecologists.


RESULTS
One hundred thirty-nine (35.8%) patients were planned for a vaginal approach, 151 (38.9%) for an abdominal approach, and 98 (25.2%) for a laparoscopic approach. The percentage of planned vaginal hysterectomies was comparable for all surgeons. There was a significant difference between the percentage of planned LHs by residents (30%) and that by general gynecologists (6%). As expected, laparoscopic-orientated gynecologists planned a laparoscopic approach in 53% of their cases.


CONCLUSIONS
LH as alternative to abdominal hysterectomy is rarely planned by general gynecologists. Residents could play a role in the implementation of LH.