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The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic
Raanan Meyer1, Rebecca J Schneyer2, Kacey M Hamilton2
1Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Drs. Meyer, Schneyer, Hamilton, Truong, Siedhoff, and Wright); The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel (Dr. Meyer).
Study Objective:
To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GOs), or general obstetrician/gynecologists (OB/GYNs).
Design:
Retrospective cohort study.
Setting:
Quaternary care academic hospital.
Patients:
Patients undergoing MIH for benign indications from March 2015 to March 2020 were included.
Interventions:
MIH.
Measurements And Main Results:
The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons' group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.36-3.71), and 25.9% of the OB/GYN group (OR, 2.65; 95% CI, 1.70-4.12). Major intra- or postoperative complications were associated with surgeons' groups (OR, 7.02; 95% CI, 2.67-18.47, and OR, 6.84; 95% CI, 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%; OR, 7.21; 95% CI, 2.52-20.60) and OB/GYNs (9.7%; OR, 7.82; 95% CI, 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs than MIGS (18.5% vs 10.9%; OR, 1.86; 95% CI, 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared with GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs than MIGS surgeons (OR, 2.12; 95% CI, 1.07-4.22; OR, 2.48; 95% CI, 1.49-4.12, respectively).
Conclusion:
Fellowship-trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.
