title: Implementation of advanced laparoscopic surgery in gynecology: national overview of trends.
abstract: OBJECTIVE
  To estimate the implementation of laparoscopic surgery in operative gynecology.
  
  
  METHODS
  Observational multicenter study (Canadian Task Force classification II-2).
  
  
  METHODS
  All hospitals in the Netherlands.
  
  
  METHODS
  Nationwide annual statistics for 2002 and 2007.
  
  
  METHODS
  A national survey of the number of performed laparoscopic and conventional procedures was performed. Laparoscopy was categorized for complexity in level 1, 2, and 3 procedures. Outcomes were compared with results from 2002 to evaluate trends.
  
  
  RESULTS
  In 2002, 21 414 laparoscopic and 9325 conventional procedures were performed in 74 hospitals (response rate, 74%), and in 2007, 16 863 laparoscopic and 10 973 conventional procedures were performed in 80 hospitals (response rate, 80%). Compared with 2002, in 2007, level 1 procedures were performed significantly less often and level 2 and level 3 procedures were performed significantly more often. The mean number of performed laparoscopic procedures per hospital decreased from 289 to 211 procedures. Teaching hospitals performed more than twice as many therapeutic laparoscopic procedures as nonteaching hospitals do. Cystectomy, oophorectomy, and ectopic pregnancy surgery were preferably performed using the laparoscopic approach. Laparoscopic hysterectomy was performed significantly more often, accounting for 10% of all hysterectomies. Annually, 20% of hospitals in which laparoscopic hysterectomy was implemented performed 50% of all laparoscopic hysterectomies, and 50% of the hospitals performed 20% of laparoscopic hysterectomies.
  
  
  CONCLUSIONS
  This study describes increasing implementation of therapeutic laparoscopic gynecologic surgery. Clinics increasingly opt to perform laparoscopic surgery rather than conventional surgery. However, implementation of advanced procedures such as laparoscopic hysterectomy seems to be hampered.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands. a.r.h.twijnstra@lumc.nl
authors.forename: A R H
authors.initials: AR
authors.lastname: Twijnstra
authors.forename: W
authors.initials: W
authors.lastname: Kolkman
authors.forename: G C M
authors.initials: GC
authors.lastname: Trimbos-Kemper
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends*; D009426:Netherlands