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Background: Minimally invasive surgery (MIS) is frequently compromised by surgical flow disturbances due to technology- and equipment-related failures. Compared with MIS in a conventional cart-based OR, performing MIS in a dedicated integrated operating room (OR) is supposed to be beneficial to patient safety. The aim of this study was to compare a conventional OR with an integrated OR with regard to the incidence and effect of equipment-related surgical flow disturbances during an advanced laparoscopic gynecological procedure [laparoscopic hysterectomy (LH)].Methods: Using video recording, 40 LHs performed between November 2010 and April 2012 (20 in a conventional cart-based OR and 20 in an integrated OR) were analyzed by two different observers. Outcome measures were the number, duration and effect (on a seven-point ordinal scale) of the surgical flow disturbances (e.g., malfunctioning, intraoperative repositioning, setup device).Results: A total of 103 h and 45 min was observed. The interobserver agreement was high (kappa .85, p < .001). Procedure time was not significantly different (NS) [conventional OR vs. integrated OR, minutes ± standard deviation (SD), mean 161 ± 27 vs. 150 ± 34]. A total of 1651 surgical flow disturbances were observed (mean ± SD per procedure 40.8 ± 19.4 vs. 41.8 ± 15.9, NS). The mean number of surgical flow disturbances per procedure with regard to equipment was 6.3 ± 3.7 versus 8.5 ± 4.0, NS. No clinically relevant differences in the mean effect of these disturbances on the surgical flow between the two OR setups were observed.Conclusions: Performing LH in an integrated OR did not reduce the number of surgical flow disturbances nor the effect of these disturbances. Furthermore, in the integrated OR, repositioning of the monitors was a frequent and time-consuming source of disturbance. In order to maintain the high standard of surgical safety, the entire surgical team has to be aware that by performing surgery in an integrated OR different potential source for disruption arise. [ABSTRACT FROM AUTHOR]

Objectives Endometrial resection is a procedure often performed for treatment of menorrhagia. Despite the fact that amenorrhoea frequently ensues, some normal endometrium can remain present and become the implantation site of a pregnancy. Such an event is uncommon (0.7%); however, the likelihood of an ectopic pregnancy is increased. This case report calls the reader's attention to the risk of intra- and extrauterine pregnancies and the necessity for contraception after endometrial resection, even in cases where amenorrhoea supervenes. Case A 46-year-old woman with prior endometrial resection and subsequent amenorrhoea, was diagnosed with a cornual pregnancy. She was successfully treated with systemic methotrexate, which was given in an outpatient clinic. Conclusion Clinicians should be aware of the increased likelihood of an ectopic pregnancy after endometrial resection. All women submitting to this procedure should be counselled about the need for contraception, even in cases where amenorrhoea develops. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effect of a mentor traineeship in laparoscopic surgery in a teaching hospital. Method: This observational study was performed between January 1997 and December 2004 at Bronovo Hospital, The Hague, The Netherlands. Since January 2001, an advanced endoscopic gynecologist has mentored a trainee in laparoscopic surgery. Data on the trainee’s procedures preceding (1997–2000) and during the mentor traineeship (2001–2004) were compared. The number and type of procedures performed, complications and conversions were derived from a prospectively kept database supplemented by a retrospective chart review. Operating times for total laparoscopic hysterectomy (TLH) were registered to establish the trainee’s learning curve. Results: Since the presence of a mentor, the trainee has performed significantly more advanced laparoscopic procedures. Despite the significant increase in advanced cases, the trainee’s laparoscopic conversion rate to laparotomy remained stable between period 1 and period 2 (7.5 and 4.5%, respectively, p = 0.35, 95% CI –0.033 to 0.092); moreover, for level-3 procedures the conversion rate decreased (p < 0.001, 95% CI 0.30–0.71). Despite the increase in advanced cases, the total complication rate remained stable (3.2–4.5%, p = 0.62, 95% CI –0.07 to 0.04) including the number of level-3 complications (p = 0.63, 95% CI –0.4 to 0.3). A decreasing trend in operating time for TLH was found; however, this was not significant (Spearman correlation coefficient –0.421, p = 0.81). Conclusions: Mentor traineeship in gynecology enhanced the advanced laparoscopic caseload. With the increase in advanced procedures, no increase in conversion rate, complication rate or operating times for TLH was found. Due to the mentorship, patients were not exposed to increased complications and conversions, or to the disadvantages of a prolonged operating time. Predominantly, mentor traineeship facilitated the implementation of laparoscopic surgery into an established gynecological practice in a teaching hospital. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Evaluation of the introduction of laparoscopic hysterectomy in a teaching hospital by means of a structured mentor-traineeship., Design: 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)., Conclusion: 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.