title: Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy.
abstract: OBJECTIVE
  Operative laparoscopy (OL) is considered the gold standard surgical treatment of ectopic pregnancy (EP). We questioned whether a training programme to foster OL treatment is able to ensure that all women needing surgical management are treated by OL irrespective of the site of EP, haemodynamic status and clinical complexity.
  
  
  METHODS
  A 13-year cohort study of 963 women who underwent surgical management was conducted. We instituted a 'universal OL' programme in 2003 for the management of all the types of EP irrespective of the haemodynamic status.
  
  
  RESULTS
  There were 802 women in the prospective (2003-2013) and 161 in the retrospective arm (2000-2002). The rate of OL before 2003 was 34%. During the year of programme implementation, the OL rate rose from 89% in 2003 to 96% in 2004. It took 4 years to achieve a 100% OL rate in haemodynamically stable patients. In 2013, we were able to achieve OL treatment for all patients irrespective of haemodynamic status, the complexity of surgery or the location of EP.
  
  
  CONCLUSIONS
  Our study demonstrates that a dedicated team with special training in minimal invasive surgery can improve surgical management of all categories of EPs, and this goal should be achievable across most units.
authors.affiliation: Whipps Cross University Hospital, Barts Health Trust, London, UK.
authors.forename: Funlayo
authors.initials: F
authors.lastname: Odejinmi
authors.forename: Ivana
authors.initials: I
authors.lastname: Rizzuto
authors.forename: Reeba
authors.initials: R
authors.lastname: Oliver
authors.forename: Aderemi
authors.initials: A
authors.lastname: Alalade
authors.forename: Nilesh
authors.initials: N
authors.lastname: Agarwal
authors.forename: Oladimeji
authors.initials: O
authors.lastname: Olowu
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D010535:Laparoscopy / Q000193:education; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*; D011274:Pregnancy, Tubal / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D006113:United Kingdom