title: Operative laparoscopy in The Netherlands: Diffusion and acceptance.
abstract: OBJECTIVE
  To evaluate and update the current status of the implementation of operative laparoscopy in gynaecology in The Netherlands by assessing diffusion and acceptance of each specific procedure per hospital.
  
  
  METHODS
  In 2003 a questionnaire was sent to all hospitals (n = 102), which addressed the total number and type of laparoscopic procedures performed in 2002 stratified by level of difficulty (level 1: diagnostic laparoscopy, sterilization, tubal patency tests; level 2: adhesiolysis, ectopic pregnancy (EP), laparoscopic treatment of endometriosis, cystectomy, oophorectomy, LAVH, tubal surgery for infertility; level 3: myomectomy, total laparoscopic hysterectomy (TLH) and sacropexy). Data were compared to previously published data of 1994.
  
  
  RESULTS
  Response rate was 79% (81/102). Diffusion and acceptance of level 2 procedures increased significantly, except endometriosis and tubal surgery for infertility. Diffusion of LAVH was only 58%. Four percent of hysterectomies were LAVH. TLH and sacropexy were not performed. The diffusion of myomectomy increased significantly (p = 0.01), whereas its acceptance remained low.
  
  
  CONCLUSIONS
  Although the diffusion of operative procedures has increased over the last decade, acceptance is still limited, especially for laparoscopic hysterectomy. The implementation of operative gynaecological laparoscopy in The Netherlands seems to develop at a slow pace.
authors.affiliation: Leiden University Medical Center, Department of Gynaecology, K6-76, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Wendela
authors.initials: W
authors.lastname: Kolkman
authors.forename: Trudy C M
authors.initials: TC
authors.lastname: Trimbos-Kemper
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D004059:Diffusion of Innovation; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D009426:Netherlands