title: Innovations in surgery: the role of residents in the implementation of laparoscopic hysterectomy.
abstract: 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.
authors: Department of Obstetrics and Gynecology, TweeSteden Hospital, Tilburg, The Netherlands. h.pijnenborg@planet.nl
authors: Johanna M A
authors: JM
authors: Pijnenborg
authors: Johanne F
authors: JF
authors: ter Haar