The place of laparoscopic surgery in surgical gynaecology

RACCE Study: Impact of an enhanced recovery after surgery program (ERAS) in the management of endometrial cancer: A single-center retrospective study

OBJECTIVE

This study evaluates the implementation of an ERAS program in the gynecological surgery department of Caen University Hospital and its impact on the management of endometrial cancer. The objective was to show its impact on the length of hospitalization of patients before and after its implementation.

PATIENTS AND METHOD

We conducted a retrospective study including all women treated surgically for endometrial cancer at Caen University Hospital between January 1, 2015 and December 31, 2021. The ERAS program started in September 2017. We compared the pre-, intra- and postoperative characteristics of two groups: the first one concerning the period before the implementation of ERAS called « prior ERAS group » and the second one after implementation called « post ERAS group ».

RESULTS

A total of 198 patients were included in our study. 139 patients were included after ERAS implementation. Our study shows that there is a significant reduction in median length of stay between the post ERAS and prior ERAS groups respectively 3 and 4 days (p = 0.004). There was also a reduction of time to resume ambulation (p < 0.001) and re-feeding (p < 0.001) for the post ERAS group compared to the prior ERAS group. Complication rates (p = 0.87) and readmission rates (p = 0.28) were not significant. Overall survival was not significant (p = 0.28).

CONCLUSION

ERAS is a safe and effective method in the overall management of patients allowing an improvement in the quality of patient care and accelerating recovery to a previous physiological state. Finally, this results in a reduction in the patient's length of stay, without impacting morbidity and readmission rate.

Initial evaluation of a new device for gynaecological laparoscopic surgery: the Atiomo-Laparoscopic Assistant™

The aim of this study was to evaluate the number of surgeons required to successfully complete a range of gynaecological laparoscopic procedures using a new device (the Atiomo-Laparoscopic Assistant™), which enables one surgeon to easily simultaneously manipulate the uterus and the laparoscope. The number of surgeons required to complete the operation in 15 women undergoing a range of laparoscopic procedures using the Atiomo-Laparoscopic Assistant™ was compared with data retrospectively collected from theatre records. It was possible for one surgeon to assess the pelvis during laparoscopy in 10 (67%) of the 15 procedures where the Atiomo-Laparoscopic Assistant™ was used, compared with 177 of the 599 (30%) procedures where it was not used (p = 0.005). However, with the Mark 3 device, it was possible for one surgeon to perform the procedure in all seven procedures (100%) where it was used. Surgeons felt that the device was easy to use and no complications occurred.

Hysterectomy and endometrial ablation in New South Wales, 1981 to 1999-2000

OBJECTIVE

To examine the trends in hysterectomy in New South Wales (NSW) from 1981 to 1999-2000 and the impact of endometrial ablation.

DATA

Computerised discharge summaries from private and public hospitals for the years 1981, 1991, 1994-1995 and 1999-2000 obtained from the NSW Health Department. All records listing hysterectomy in women over the age of 20 in each period were selected and those listing endometrial ablation since 1991 were also selected. Operative procedure, diagnosis, hospital type, length of stay and demographic data were recorded. Annual figures since 1988-1989 for hysterectomy and ablation were also obtained.

FINDINGS

Initially it appeared that the introduction of endometrial ablation might reduce hysterectomy rates, but the combined rate of hysterectomy and endometrial ablation continued to rise to a peak in 1992-1993 and has declined since. The hysterectomy rate in 1999-2000 was lower than in 1981. There has been a marked shift from abdominal to vaginal hysterectomy, with an increase in laparoscopically assisted operations. Overall, the mean age at operation has been rising, although the mean age for vaginal hysterectomy has fallen. The shift to private hospitals and reduction in hospital stay have continued.

CONCLUSION

The trends are consistent with the increased use of laparoscopic and ablation techniques, improvements in hormonal contraceptive use, and better access to abortion, which have facilitated women's decisions to postpone their births and to conserve their childbearing to older ages. Further development of these techniques will have an impact on gynaecological training and practice in the next decade.