Implementation of advanced laparoscopy into daily gynecologic practice: difficulties and solutions

The implementation of laparoscopy into Dutch gynecologic practice is slow. This study was conducted to assess the current state of laparoscopy, to identify factors influencing the implementation and to find solutions toward a better implementation.

In 2003 a questionnaire was sent to all 151 gynecologists who finished residency within the previous 5 years. The questionnaire addressed practice demographics, performance of laparoscopy, factors influencing use of laparoscopy in practice and means of obtaining laparoscopic skills after residency.

Of 151 gynecologists, 124 (82%) responded, 46 (37%) male and 78 (63%) female. Mean age was 39 years (range 32-47 years). Respondents (73%) believed they were adequately trained during residency for basic laparoscopic procedures, but not for the more advanced procedures (82%). Lack of caseload, lack of being a primary surgeon, and lack of simulator training caused the deficiency of laparoscopic skills at the end of the residency. Causes of the slow implementation were long operating time, lack of attention for laparoscopy during residency, and budgetary problems, but not the financial compensation for gynecologists. In current practice, only 9% believed they reached their preferred level of competence. Hiring an advanced laparoscopic gynecologist was believed to be the best opportunity to reach the preferred level of competence. A minority of respondents supported a referral system or fellowship program.

Basic laparoscopy is sufficiently mastered during residency training; however, advanced laparoscopy is not. More emphasis should be placed on laparoscopic training of advanced procedures during residency and for gynecologists in practice. Hiring a gynecologist with advanced laparoscopic skills is expected to be the solution for this problem. However, a referral system or fellowship program is not.