[Safe introduction of laparoscopic hysterectomy using a mentor].
OBJECTIVE
Evaluation of the introduction of laparoscopic hysterectomy in a teaching hospital by means of a structured mentor-traineeship.


METHODS
Retrospective, with prospectively designed database.


METHODS
By means of a mentor-traineeship the technique of laparoscopic hysterectomy was introduced to two gynaecologists in a teaching hospital. The primary outcome measures of the laparoscopic hysterectomies were duration of the operation, blood loss and complications. In addition, patient characteristics as well as main indication for surgery were analysed. The training period was defined per trainee as the relationship between operation duration and consecutive operations. Similar outcome measures of all laparoscopic hysterectomies performed during the same period by the mentor in his own hospital were used as a reference.


RESULTS
During both mentor-traineeships, the main indication for surgery, the operation characteristics and the percentage of complications were comparable between trainee and mentor (p = 0.633). The operating time did not differ clinically significantly between trainee and mentor. Both trainees realised a learning curve, while the operating time remained statistically constant and comparable to that of the mentor. During the mentor-traineeships and the two following years the number of laparoscopic hysterectomies increased (p = 0.001), while the number of abdominal hysterectomies diminished (p = 0.002).


CONCLUSIONS
A mentor was able to effectively introduce laparoscopic hysterectomy in a clinic without jeopardizing patient safety, as main indication, operating time and percentage of complications were comparable to those of the mentor in his/her own hospital. Due to this safe method of introduction of the new procedure more patients are able to benefit from the advantages of this surgical technique.
Leids Universitair Medisch Centrum, afd. Gynaecologie, Leiden, The Netherlands.
Mathijs D
MD
Blikkendaal
Andries R H
AR
Twijnstra
Maddy J G H
MJ
Smeets
Johann P T
JP
Rhemrev
Frank Willem
FW
Jansen
D000328:Adult; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D010535:Laparoscopy; D008611:Mentors; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014146:Training Support