Introduction of a laparoscopic gynecological program in a general hospital in Taiwan.
OBJECTIVE
We reviewed the records for 571 gynecologic laparoscopies performed at a privately owned general hospital in Kaosiung Taiwan in 1998 and 1999 and discuss here the major obstacles we encountered while introducing these procedures at our institution.


METHODS
Included in this series are 293 procedures performed in 1998 (149 hysterectomies, 144 adnexal procedures), and 278 procedures performed in 1999 (131 hysterectomies, 147 adnexal procedures). Thirty-nine of these patients also underwent laparoscopic appendectomy. Mean patient age was 62 years (range 28 to 82). All procedures were performed by 1 of 6 board-certified gynecologic surgeons, or by 1 of 4 residents under the direct supervision of a board-certified surgeon.


RESULTS
We experienced 0% mortality and 7.2% morbidity in this series. In comparing cases from 1998 and 1999, we observed a decrease in both mean surgery time (135.4 to 123.0, P=0.032) and mean length of hospital stay (5.52 to 4.62, P=0.046) for hysterectomies and adnexal procedures combined.


CONCLUSIONS
These data support ongoing efforts to incorporate gynecologic laparoscopy as an alternative to open procedures at our institution. Introduction of these procedures in privately owned hospitals in Taiwan has been limited because of the large initial investment for equipment, patient education issues, and difficulties obtaining reimbursement.
Department of Obstetrics and Gynecology, Yuan's Memorial Hospital, Kaosiung, Taiwan.
Yung Hsien
YH
Liu
Besen
B
Yu
Chin Ming
CM
Wu
Hwee May
HM
Lin
Tsong
T
Fuchen
Chau-Su
CS
Ou
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008875:Middle Aged; D009026:Mortality; D013624:Taiwan