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Trainee Involvement at Vaginal Hysterectomy: A Canadian Multicentre Retrospective Review.

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Residents are less involved in vaginal hysterectomy (VH) than laparoscopic hysterectomy (LH). When residents assist in VH, surgical outcomes like operative time and complications worsen compared to staff assistance.

Keywords:
medical educationresidencyvaginal hysterectomy

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Area of Science:

  • Minimally invasive gynecologic surgery
  • Surgical education
  • Patient safety

Background:

  • Postgraduate trainee involvement in hysterectomy procedures is crucial for surgical education.
  • Vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) are common minimally invasive surgical techniques.
  • Understanding trainee participation and its impact on outcomes is essential for optimizing surgical training and patient care.

Purpose of the Study:

  • To compare postgraduate obstetrics and gynaecology trainee involvement in vaginal hysterectomy (VH) versus laparoscopic hysterectomy (LH) and laparoscopic-assisted vaginal hysterectomy.
  • To investigate the effect of trainee involvement on VH surgical outcomes.

Main Methods:

  • Multicenter retrospective cohort study of minimally invasive surgical (MIS) hysterectomies (2016-2022).
  • Comparison of patient, surgery, and surgeon characteristics across MIS hysterectomy types.
  • Multivariable logistic regression to identify factors associated with VH and trainee presence.
  • Analysis of VH surgical outcomes based on first-assistant training level (staff, fellow, resident).

Main Results:

  • Out of 5246 hysterectomies, 1491 were VHs, 3352 LHs, and 403 laparoscopic-assisted vaginal hysterectomies.
  • Trainees were involved in 78.0% of cases, less frequently in VH (76.8%) than LH (79.5%).
  • VHs with residents as first assistant showed longer operative time (151 vs. 102 min), higher blood loss (200 vs. 100 cc), and more complications/readmissions (28.9% vs. 15.4%) compared to staff assistance.

Conclusions:

  • Resident involvement is less frequent in vaginal hysterectomy compared to laparoscopic hysterectomy.
  • When residents act as the first assistant in VH, surgical outcomes are negatively impacted compared to staff assistance.