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Friedericy HJ, Friedericy AF, de Weger A, van Dorp ELA, Traversari RAAL, van der Eijk AC, Jansen FW. Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow. J Hosp Infect 2024; 148:51-57. [PMID: 38537748 DOI: 10.1016/j.jhin.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF). AIM To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF. METHODS This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used. FINDINGS Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4-1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA. CONCLUSION Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to high electricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgery can diminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.
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Affiliation(s)
- H J Friedericy
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - A F Friedericy
- Department of Health Sciences, Free University of Amsterdam, Amsterdam, The Netherlands
| | - A de Weger
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - E L A van Dorp
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - A C van der Eijk
- Operating Room Department and Central Sterile Supply Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - F W Jansen
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Faculty of Biomedical Engineering, Delft University of Technology, Delft, The Netherlands
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van de Berg NJ, van den Dobbelsteen JJ, Jansen FW, Grimbergen CA, Dankelman J. Correction to: Energetic soft-tissue treatment technologies: an overview of procedural fundamentals and safety factors. Surg Endosc 2022; 36:5546. [PMID: 35477808 DOI: 10.1007/s00464-022-09298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N J van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - J J van den Dobbelsteen
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - F W Jansen
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD, Delft, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - C A Grimbergen
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD, Delft, The Netherlands.,Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, Jansen FW, Mulders AGMGJ, Padmehr R, Clark TJ, van Vliet HA, Stephenson MD, van der Veen F, Mol BWJ, van Wely M, Goddijn M. Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial. Hum Reprod 2021; 36:1260-1267. [PMID: 33793794 PMCID: PMC8058590 DOI: 10.1093/humrep/deab037] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Does septum resection improve reproductive outcomes in women with a septate uterus? SUMMARY ANSWER Hysteroscopic septum resection does not improve reproductive outcomes in women with a septate uterus. WHAT IS KNOWN ALREADY A septate uterus is a congenital uterine anomaly. Women with a septate uterus are at increased risk of subfertility, pregnancy loss and preterm birth. Hysteroscopic resection of a septum may improve the chance of a live birth in affected women, but this has never been evaluated in randomized clinical trials. We assessed whether septum resection improves reproductive outcomes in women with a septate uterus, wanting to become pregnant. STUDY DESIGN, SIZE, DURATION We performed an international, multicentre, open-label, randomized controlled trial in 10 centres in The Netherlands, UK, USA and Iran between October 2010 and September 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with a septate uterus and a history of subfertility, pregnancy loss or preterm birth were randomly allocated to septum resection or expectant management. The primary outcome was conception leading to live birth within 12 months after randomization, defined as the birth of a living foetus beyond 24 weeks of gestational age. We analysed the data on an intention-to-treat basis and calculated relative risks with 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE We randomly assigned 80 women with a septate uterus to septum resection (n = 40) or expectant management (n = 40). We excluded one woman who underwent septum resection from the intention-to-treat analysis, because she withdrew informed consent for the study shortly after randomization. Live birth occurred in 12 of 39 women allocated to septum resection (31%) and in 14 of 40 women allocated to expectant management (35%) (relative risk (RR) 0.88 (95% CI 0.47 to 1.65)). There was one uterine perforation which occurred during surgery (1/39 = 2.6%). LIMITATIONS, REASONS FOR CAUTION Although this was a major international trial, the sample size was still limited and recruitment took a long period. Since surgical techniques did not fundamentally change over time, we consider the latter of limited clinical significance. WIDER IMPLICATIONS OF THE FINDINGS The trial generated high-level evidence in addition to evidence from a recently published large cohort study. Both studies unequivocally do not reveal any improvements in reproductive outcomes, thereby questioning any rationale behind surgery. STUDY FUNDING/COMPETING INTEREST(S) There was no study funding. M.H.E. reports a patent on a surgical endoscopic cutting device and process for the removal of tissue from a body cavity licensed to Medtronic, outside the scope of the submitted work. H.A.v.V. reports personal fees from Medtronic, outside the submitted work. B.W.J.M. reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck Merck KGaA, personal fees from Guerbet, personal fees from iGenomix, outside the submitted work. M.G. reports several research and educational grants from Guerbet, Merck and Ferring (location VUMC) outside the scope of the submitted work. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER Dutch trial registry: NTR 1676. TRIAL REGISTRATION DATE 18 February 2009. DATE OF FIRST PATIENT’S ENROLMENT 20 October 2010.
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Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - C R Kowalik
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - R Padmehr
- Department of Obstetrics and Gynaecology, Avicenna Research Institute, Tehran, Iran
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - H A van Vliet
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois at Chicago, Chicago, IL, USA
| | - F van der Veen
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia
| | - M van Wely
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
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Metzemaekers J, Lust E, Rhemrev J, Van Geloven N, Twijnstra A, Van Der Westerlaken L, Jansen FW. Prognosis in fertilisation rate and outcome in IVF cycles in patients with and without endometriosis: a population-based comparative cohort study with controls. Facts Views Vis Obgyn 2021; 13:27-34. [PMID: 33889858 PMCID: PMC8051192 DOI: 10.52054/fvvo.13.1.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Subfertility occurs in 30-40% of endometriosis patients. Regarding the fertilisation rate with in vitro fertilisation (IVF) and endometriosis, conflicting data has been published. This study aimed to compare endometriosis patients to non-endometriosis cycles assessing fertilisation rates in IVF. Methods: A population-based cohort study was conducted at the Leiden University Medical Center. IVF cycles of endometriosis patients and controls (unexplained infertility and tubal pathology) were analysed. The main outcome measurement was fertilisation rate. Results: 503 IVF cycles in total, 191 in the endometriosis group and 312 in the control. The mean fertilisation rate after IVF did not differ between both groups, 64.1%±25.5 versus 63.9%±24.8 (p=0.95) respectively, independent of age and r-ASRM classification. The median number of retrieved oocytes was lower in the endometriosis group (7.0 versus 8.0 respectively, p=0.19) and showed a significant difference when corrected for age (p=0.02). When divided into age groups, the statistical effect was only seen in the group of ≤ 35 years (p=0.04). In the age group ≤35, the endometriosis group also showed significantly more surgery on the internal reproductive organs compared to the control group (p<0.001). All other outcomes did not show significant differences. Conclusion: Similar fertilisation rates were found in endometriosis IVF cycles compared to controls. The oocyte retrieval was lower in the endometriosis group, however this effect was only significant in the age group ≤ 35 years. All other secondary outcomes did not show significant differences. In general, endometriosis patients with an IVF indication can be counselled positively regarding the chances of becoming pregnant, and do not need a different IVF approach.
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Affiliation(s)
- J Metzemaekers
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eer Lust
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jpt Rhemrev
- Department of Gynaecology, Haaglanden Medisch Centrum-Bronovo, Den Haag, the Netherlands
| | - N Van Geloven
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arh Twijnstra
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - L Van Der Westerlaken
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - F W Jansen
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, Krentel H, Janschek E, Exacoustos C, Malzoni M, Mueller M, Roman H, Condous G, Forman A, Jansen FW, Bokor A, Simedrea V, Hudelist G. The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 2021; 100:1165-1175. [PMID: 33483970 DOI: 10.1111/aogs.14099] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/09/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022]
Abstract
Advances in preoperative diagnostics as well as in surgical techniques for the treatment of endometriosis, especially for deep endometriosis, call for a classification system, that includes all aspects of the disease such as peritoneal endometriosis, ovarian endometriosis, deep endometriosis, and secondary adhesions. The widely accepted revised American Society for Reproductive Medicine classification (rASRM) has certain limitations because of its incomplete description of deep endometriosis. In contrast, the Enzian classification, which has been implemented in the last decade, has proved to be the most suitable tool for staging deep endometriosis, but does not include peritoneal or ovarian disease or adhesions. To overcome these limitations, a comprehensive classification system for complete mapping of endometriosis, including anatomical location, size of the lesions, adhesions and degree of involvement of the adjacent organs, that can be used with both diagnostic and surgical methods, has been created through a consensus process and will be described in detail-the #Enzian classification.
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Affiliation(s)
- Jörg Keckstein
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Endometriosis Clinic Dres. Keckstein, Villach, Austria.,University of Ulm, Germany
| | - Ertan Saridogan
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK
| | - Uwe A Ulrich
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Endometriosis Center, Martin Luther Hospital, Berlin, Germany
| | - Martin Sillem
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Praxisklinik am Rosengarten, Mannheim, Germany.,Department of Obstetrics and Gynecology, Saarland University Medical School, Homburg, Germany
| | - Peter Oppelt
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department for Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Austria
| | - Karl W Schweppe
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany
| | - Harald Krentel
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Bethesda Hospital, Duisburg, Germany
| | - Elisabeth Janschek
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Villach General Hospital, Villach, Austria
| | - Caterina Exacoustos
- Department of Obstetrics and Gynecology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Malzoni
- Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Michael Mueller
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Sydney Medical School Nepean, University of Sydney Nepean Hospital, Sydney, Australia
| | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Frank W Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Voicu Simedrea
- Department of Obstetrics and Gynecology, Regina Maria Clinic, Timisoara, Romania
| | - Gernot Hudelist
- Scientific Endometriosis Foundation (Stiftung Endometriose-Forschung/ SEF, Westerstede, Germany.,Department of Gynaecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
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6
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Metzemaekers J, Haazebroek P, Smeets MJGH, English J, Blikkendaal MD, Twijnstra ARH, Adamson GD, Keckstein J, Jansen FW. EQUSUM: Endometriosis QUality and grading instrument for SUrgical performance: proof of concept study for automatic digital registration and classification scoring for r-ASRM, EFI and Enzian. Hum Reprod Open 2020; 2020:hoaa053. [PMID: 33409380 PMCID: PMC7772248 DOI: 10.1093/hropen/hoaa053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Is electronic digital classification/staging of endometriosis by the EQUSUM application more accurate in calculating the scores/stages and is it easier to use compared to non-digital classification? SUMMARY ANSWER We developed the first digital visual classification system in endometriosis (EQUSUM). This merges the three currently most frequently used separate endometriosis classification/scoring systems (i.e. revised American Society for Reproductive Medicine (rASRM), Enzian and Endometriosis Fertility Index (EFI)) to allow uniform and adequate classification and registration, which is easy to use. The EQUSUM showed significant improvement in correctly classifying/scoring endometriosis and is more user-friendly compared to non-digital classification. WHAT IS KNOWN ALREADY Endometriosis classification is complex and until better classification systems are developed and validated, ideally all women with endometriosis undergoing surgery should have a correct rASRM score and stage, while women with deep endometriosis (DE) should have an Enzian classification and if there is a fertility wish, the EFI score should be calculated. STUDY DESIGN SIZE DURATION A prospective endometriosis classification proof of concept study under experts in deep endometriosis was conducted. A comparison was made between currently used non-digital classification formats for endometriosis versus a newly developed digital classification application (EQUSUM). PARTICIPANTS/MATERIALS SETTING METHODS A hypothetical operative endometriosis case was created and summarized in both non-digital and digital form. During European endometriosis expert meetings, 45 DE experts were randomly assigned to the classic group versus the digital group to provide a proper classification of this DE case. Each expert was asked to provide the rASRM score and stage, Enzian and EFI score. Twenty classic forms and 20 digital forms were analysed. Questions about the user-friendliness (system usability scale (SUS) and subjective mental effort questionnaire (SMEQ)) of both systems were collected. MAIN RESULTS AND THE ROLE OF CHANCE The rASRM stage was scored completely correctly by 10% of the experts in the classic group compared to 75% in the EQUSUM group (P < 0. 01). The rASRM numerical score was calculated correctly by none of the experts in the classic group compared with 70% in the EQUSUM group (P < 0.01). The Enzian score was correct in 60% of the classic group compared to 90% in the EQUSUM group (P = 0.03). EFI scores were calculated correctly in 25% of the classic group versus 85% in the EQUSUM group (P < 0.01). Finally, the usability measured with the SUS was significantly better in the EQUSUM group compared to the classic group: 80.8 ± 11.4 and 61.3 ± 20.5 (P < 0.01). Also the mental effort measured with the SMEQ was significant lower in the EQUSUM group compared to the classic group: 52.1 ± 18.7 and 71.0 ± 29.1 (P = 0.04). Future research should further develop and confirm these initial findings by conducting similar studies with larger study groups, to limit the possible role of chance. LIMITATIONS REASONS FOR CAUTION These first results are promising, however it is important to note that this is a preliminary result of experts in DE and needs further testing in daily practice with different types (complex and easy) of endometriosis cases and less experienced gynaecologists in endometriosis surgery. WIDER IMPLICATIONS OF THE FINDINGS This is the first time that the rASRM, Enzian and EFI are combined in one web-based application to simplify correct and automatic endometriosis classification/scoring and surgical registration through infographics. Collection of standardized data with the EQUSUM could improve endometriosis reporting and increase the uniformity of scientific output. However, this requires a broad implementation. STUDY FUNDING/COMPETING INTERESTS To launch the EQUSUM application, a one-time financial support was provided by Medtronic to cover the implementation cost. No competing interests were declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J Metzemaekers
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - P Haazebroek
- Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - M J G H Smeets
- Department of Gynaecology, Haaglanden Medisch Centrum-Bronovo, Den Haag, the Netherlands
| | - J English
- Department of Gynaecology, Haaglanden Medisch Centrum-Bronovo, Den Haag, the Netherlands
| | - M D Blikkendaal
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - A R H Twijnstra
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - J Keckstein
- Stiftung Endometrioseforschung (SEF), Westerstede,Germany
- Gynecological Clinic Drs. Keckstein, Villach, Austria
| | - F W Jansen
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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7
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker W, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1578-1588. [PMID: 32353142 PMCID: PMC7368397 DOI: 10.1093/humrep/dez284] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Does septum resection improve reproductive outcomes in women with a septate uterus? SUMMARY ANSWER In women with a septate uterus, septum resection does not increase live birth rate nor does it decrease the rates of pregnancy loss or preterm birth, compared with expectant management. WHAT IS KNOWN ALREADY The septate uterus is the most common uterine anomaly with an estimated prevalence of 0.2-2.3% in women of reproductive age, depending on the classification system. The definition of the septate uterus has been a long-lasting and ongoing subject of debate, and currently two classification systems are used worldwide. Women with a septate uterus may be at increased risk of subfertility, pregnancy loss, preterm birth and foetal malpresentation. Based on low quality evidence, current guidelines recommend removal of the intrauterine septum or, more cautiously, state that the procedure should be evaluated in future studies. STUDY DESIGN, SIZE, DURATION We performed an international multicentre cohort study in which we identified women mainly retrospectively by searching in electronic patient files, medical records and databases within the time frame of January 2000 until August 2018. Searching of the databases, files and records took place between January 2016 and July 2018. By doing so, we collected data on 257 women with a septate uterus in 21 centres in the Netherlands, USA and UK. PARTICIPANTS/MATERIALS, SETTING, METHODS We included women with a septate uterus, defined by the treating physician, according to the classification system at that time. The women were ascertained among those with a history of subfertility, pregnancy loss, preterm birth or foetal malpresentation or during a routine diagnostic procedure. Allocation to septum resection or expectant management was dependent on the reproductive history and severity of the disease. We excluded women who did not have a wish to conceive at time of diagnosis. The primary outcome was live birth. Secondary outcomes included pregnancy loss, preterm birth and foetal malpresentation. All conceptions during follow-up were registered but for the comparative analyses, only the first live birth or ongoing pregnancy was included. To evaluate differences in live birth and ongoing pregnancy, we used Cox proportional regression to calculate hazard rates (HRs) and 95% CI. To evaluate differences in pregnancy loss, preterm birth and foetal malpresentation, we used logistic regression to calculate odds ratios (OR) with corresponding 95% CI. We adjusted all reproductive outcomes for possible confounders. MAIN RESULTS AND THE ROLE OF CHANCE In total, 257 women were included in the cohort. Of these, 151 women underwent a septum resection and 106 women had expectant management. The median follow-up time was 46 months. During this time, live birth occurred in 80 women following a septum resection (53.0%) compared to 76 women following expectant management (71.7%) (HR 0.71 95% CI 0.49-1.02) and ongoing pregnancy occurred in 89 women who underwent septum resection (58.9%), compared to 80 women who had expectant management (75.5%) (HR 0.74 (95% CI 0.52-1.06)). Pregnancy loss occurred in 51 women who underwent septum resection (46.8%) versus 31 women who had expectant management (34.4%) (OR 1.58 (0.81-3.09)), while preterm birth occurred in 26 women who underwent septum resection (29.2%) versus 13 women who had expectant management (16.7%) (OR 1.26 (95% CI 0.52-3.04)) and foetal malpresentation occurred in 17 women who underwent septum resection (19.1%) versus 27 women who had expectant management (34.6%) (OR 0.56 (95% CI 0.24-1.33)). LIMITATIONS, REASONS FOR CAUTION Our retrospective study has a less robust design compared with a randomized controlled trial. Over the years, the ideas about the definition of the septate uterus has changed, but since the 257 women with a septate uterus included in this study had been diagnosed by their treating physician according to the leading classification system at that time, the data of this study reflect the daily practice of recent decades. Despite correcting for the most relevant patient characteristics, our estimates might not be free of residual confounding. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that septum resection, a procedure that is widely offered and associated with financial costs for society, healthcare systems or individuals, does not lead to improved reproductive outcomes compared to expectant management for women with a septate uterus. The results of this study need to be confirmed in randomized clinical trials. STUDY FUNDING/COMPETING INTEREST(S) A travel for JFWR to Chicago was supported by the Jo Kolk Studyfund. Otherwise, no specific funding was received for this study. The Department of Obstetrics and Gynaecology, University Medical Centre, Groningen, received an unrestricted educational grant from Ferring Pharmaceutical Company unrelated to the present study. BWM reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck, personal fees from Guerbet, other payment from Guerbet and grants from Merck, outside the submitted work. The other authors declare no conficts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the Netherlands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker WKH, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Corrigendum. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1722. [PMID: 32472131 PMCID: PMC7368394 DOI: 10.1093/humrep/deaa141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the NetherNetherlandslands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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van Barneveld E, Veth VB, Sampat JM, Schreurs AMF, van Wely M, Bosmans JE, de Bie B, Jansen FW, Klinkert ER, Nap AW, Mol BWJ, Bongers MY, Mijatovic V, Maas JWM. SOMA-trial: surgery or medication for women with an endometrioma? Study protocol for a randomised controlled trial and cohort study. Hum Reprod Open 2020; 2020:hoz046. [PMID: 33033754 PMCID: PMC7528444 DOI: 10.1093/hropen/hoz046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/31/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTIONS The objective of this study is to evaluate the effectiveness and cost-effectiveness of surgical treatment of women suffering from pain due to an ovarian endometrioma when compared to treatment with medication (analgesia and/or hormones). The primary outcome is defined as successful pain reduction (-30% reduction of pain) measured by the numeric rating scale (NRS) after 6 months. Secondary outcomes include successful pain reduction after 12 and 18 months, quality of life, affective symptoms, cost-effectiveness, recurrence rate, need of adjuvant medication after surgery, ovarian reserve, adjuvant surgery and budget impact. WHAT IS KNOWN ALREADY Evidence suggests that both medication and surgical treatment of an ovarian endometrioma are effective in reducing pain and improving quality of life. However, there are no randomised studies that compare surgery to treatment with medication. STUDY DESIGN SIZE DURATION This study will be performed in a research network of university and teaching hospitals in the Netherlands. A multicentre randomised controlled trial and parallel prospective cohort study in patients with an ovarian endometrioma, with the exclusion of patients with deep endometriosis, will be conducted. After obtaining informed consent, eligible patients will be randomly allocated to either treatment arm (medication or surgery) by using web-based block randomisation stratified per centre. A successful pain reduction is set at a 30% decrease on the NRS at 6 months after randomisation. Based on a power of 80% and an alpha of 5% and using a continuity correction, a sample size of 69 patients in each treatment arm is needed. Accounting for a drop-out rate of 25% (i.e. loss to follow up), we need to include 92 patients in each treatment arm, i.e. 184 in total. Simultaneously, a cohort study will be performed for eligible patients who are not willing to be randomised because of a distinct preference for one of the two treatment arms. We intend to include 100 women in each treatment arm to enable standardization by inverse probability weighting, which means 200 patients in total. The expected inclusion period is 24 months with a follow-up of 18 months. PARTICIPANTS/MATERIALS SETTING METHODS Premenopausal women (age ≥ 18 years) with pain (dysmenorrhoea, pelvic pain or dyspareunia) and an ovarian endometrioma (cyst diameter ≥ 3 cm) who visit the outpatient clinic will make up the study population. Patients with signs of deep endometriosis will be excluded. The primary outcome is successful pain reduction, which is defined as a 30% decrease of pain on the NRS at 6 months after randomisation. Secondary outcomes include successful pain reduction after 12 and 18 months, quality of life and affective symptoms, cost-effectiveness (from a healthcare and societal perspective), number of participants needing additional surgery, need of adjuvant medication after surgery, ovarian reserve and recurrence rate of endometriomas. Measurements will be performed at baseline, 6 weeks and 6, 12 and 18 months after randomisation. STUDY FUNDING/COMPETING INTERESTS This study is funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-85200-98-91041. The Department of Reproductive Medicine of the Amsterdam UMC location VUmc has received several research and educational grants from Guerbet, Merck KGaA and Ferring not related to the submitted work. B.W.J. Mol is supported by a NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy for ObsEva, Merck KGaA and Guerbet. V. Mijatovic reports grants from Guerbet, grants from Merck and grants from Ferring outside the submitted work. All authors declare that they have no competing interests concerning this publication. TRIAL REGISTRATION NUMBER Dutch Trial Register (NTR 7447, http://www.trialregister.nl). TRIAL REGISTRATION DATE 2 January 2019. DATE OF FIRST PATIENT’S ENROLMENT First inclusion in randomised controlled trial October 4, 2019. First inclusion in cohort May 22, 2019.
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Affiliation(s)
- E van Barneveld
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Research School Grow, Maastricht University, Maastricht, the Netherlands
| | - V B Veth
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Research School Grow, Maastricht University, Maastricht, the Netherlands
| | - J M Sampat
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Research School Grow, Maastricht University, Maastricht, the Netherlands
| | - A M F Schreurs
- Department of Reproductive Medicine, Endometriosis Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M van Wely
- Methodology, Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - B de Bie
- Endometriosis Foundation of the Netherlands (Endometriose Stichting), Sittard, The Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, University of Leiden, Leiden, the Netherlands
| | - E R Klinkert
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A W Nap
- Department of Obstetrics and Gynaecology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre Melbourne, Melbourne, Australia
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
- Research School Grow, Maastricht University, Maastricht, the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Endometriosis Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J W M Maas
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
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Berger JP, Rhemrev J, Smeets M, Henneman O, English J, Jansen FW. Limited Added Value of Magnetic Resonance Imaging After Dynamic Transvaginal Ultrasound for Preoperative Staging of Endometriosis in Daily Practice: A Prospective Cohort Study. J Ultrasound Med 2019; 38:989-996. [PMID: 30244483 PMCID: PMC7379645 DOI: 10.1002/jum.14783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess the added value of magnetic resonance imaging (MRI) after dynamic transvaginal ultrasound (TVUS) in the diagnostic pathway for preoperative staging of pelvic endometriosis. METHODS A prospective observational study was conducted between April 22, 2014, and May 1, 2015. During that period, 363 patients with a clinical suspicion of endometriosis were included. All patients underwent a history, clinical examination, and dynamic TVUS examination. Most of the patients (n = 274) underwent conservative treatment according to the European Society of Human Reproduction and Embryology guidelines. Eighty-nine patients were selected for surgery, of whom 72 patients underwent the complete diagnostic pathway: ie, history, clinical examination, dynamic TVUS, and MRI. All data were analyzed by the nonparametric McNemar test for comparing each step in the diagnostic algorithm. RESULTS The sensitivity and specificity for the history, pelvic examination, and dynamic TVUS were 93.7% and 55.6% (P < .001), respectively; when MRI findings were included, the sensitivity and specificity were 85.9% and 62.5%. Adding MRI routinely to the diagnostic procedure of endometriosis did not significantly improve the sensitivity or specificity. CONCLUSIONS There is no significant added value of routine MRI after dynamic TVUS for the preoperative staging of endometriosis.
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Affiliation(s)
- Judith P. Berger
- Bronovo HospitalBronovolaanthe Netherlands
- Leiden University Medical CenterLeidenthe Netherlands
| | | | | | | | | | - Frank W. Jansen
- Leiden University Medical CenterLeidenthe Netherlands
- Technical University of DelftDelftthe Netherlands
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11
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Sandberg EM, Twijnstra A, van Meir CA, Kok HS, van Geloven N, Gludovacz K, Kolkman W, Nagel H, Haans L, Kapiteijn K, Jansen FW. Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial. BJOG 2019; 126:804-813. [PMID: 30548529 PMCID: PMC6593458 DOI: 10.1111/1471-0528.15580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 11/29/2022]
Abstract
Objective To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR). Study design Non‐inferiority randomised controlled trial. Population Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. Methods Women were randomised to ICR or DCR (between 18 and 24 hours after surgery). Primary outcome The inability to void within 6 hours after catheter removal. Results One hundred and fifty‐five women were randomised to ICR (n = 74) and DCR (n = 81). The intention‐to‐treat and per‐protocol analysis could not demonstrate the non‐inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6–24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference −5.8%, −15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8–23.3 versus 21.0 hours, 1.4–29.9; P ≤ 0.001). Conclusion The non‐inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy. Tweetable abstract The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention. The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.
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Affiliation(s)
- E M Sandberg
- Department of Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - Arh Twijnstra
- Department of Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - C A van Meir
- Department of Gynaecology, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | - H S Kok
- Departement of Gynaecology, Alrijne Ziekenhuis, Leiden/Leiderdorp, the Netherlands
| | - N van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - K Gludovacz
- Departement of Gynaecology, Alrijne Ziekenhuis, Leiden/Leiderdorp, the Netherlands
| | - W Kolkman
- Department of Gynaecology, HagaZiekenhuis, The Hague, the Netherlands
| | - Htc Nagel
- Department of Gynaecology, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - Lcf Haans
- Department of Gynaecology, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - K Kapiteijn
- Department of Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - F W Jansen
- Department of Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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12
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Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, de Kruif JH, Bloemenkamp KWM, Jansen FW, Veersema S, Mulders AGMGJ, Thurkow AL, Hald K, Mohazzab A, Khalaf Y, Clark TJ, Farrugia M, van Vliet HA, Stephenson MS, van der Veen F, van Wely M, Mol BWJ, Goddijn M. The randomised uterine septum transsection trial (TRUST): design and protocol. BMC Womens Health 2018; 18:163. [PMID: 30290803 PMCID: PMC6173848 DOI: 10.1186/s12905-018-0637-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/23/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus. METHODS/DESIGN A multi-centre randomised controlled trial comparing hysteroscopic septum resection and expectant management in women with recurrent miscarriage or subfertility and diagnosed with a septate uterus. The primary outcome is live birth, defined as the birth of a living foetus beyond 24 weeks of gestational age. Secondary outcomes are ongoing pregnancy, clinical pregnancy, miscarriage and complications following hysteroscopic septum resection. The analysis will be performed according to the intention to treat principle. Kaplan-Meier curves will be constructed, estimating the cumulative probability of conception leading to live birth rate over time. Based on retrospective studies, we anticipate an improvement of the live birth rate from 35% without surgery to 70% with surgery. To demonstrate this difference, 68 women need to be randomised. DISCUSSION Hysteroscopic septum resection is worldwide considered as a standard procedure in women with a septate uterus. Solid evidence for this recommendation is lacking and data from randomised trials is urgently needed. TRIAL REGISTRATION Dutch trial registry ( NTR1676 , 18th of February 2009).
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Affiliation(s)
- J F W Rikken
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - C R Kowalik
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M H Emanuel
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - M Y Bongers
- Maxima Medical Centre, de Run 4600, 5504, DB, Veldhoven, The Netherlands
| | - T Spinder
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934, AD, Leeuwarden, the Netherlands
| | - J H de Kruif
- Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS, Nijmegen, The Netherlands
| | - K W M Bloemenkamp
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - F W Jansen
- University Medical Centre Leiden, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - S Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - A G M G J Mulders
- Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - A L Thurkow
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - K Hald
- Oslo University Hospital, P. O. Box 4950, Nydalen, N-0424, Oslo, Norway
| | - A Mohazzab
- Avicenna research institute Teheran, PO Box: 19615-1177, Teheran, Postal code: 1936773493, Iran
| | - Y Khalaf
- Guy's hospital, Great maze pond, London, SE1 9RT, UK
| | - T J Clark
- Birmingham women's hospital, Mindelsohn Way, Birmingham, West Midlands, B15 2TG, UK
| | - M Farrugia
- East Kent Hospitals University, Ethelbert road, Canterbury, Kent, CT1 3NG, UK
| | - H A van Vliet
- Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - M S Stephenson
- University of Illinois Hospital, 1740 W Taylor St, Chicago, IL, 60612, USA
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - M Goddijn
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands.
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13
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Meeuwsen FC, van Luyn F, Blikkendaal MD, Jansen FW, van den Dobbelsteen JJ. Surgical phase modelling in minimal invasive surgery. Surg Endosc 2018; 33:1426-1432. [PMID: 30187202 PMCID: PMC6484813 DOI: 10.1007/s00464-018-6417-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 08/31/2018] [Indexed: 12/04/2022]
Abstract
Background Surgical Process Modelling (SPM) offers the possibility to automatically gain insight in the surgical workflow, with the potential to improve OR logistics and surgical care. Most studies have focussed on phase recognition modelling of the laparoscopic cholecystectomy, because of its standard and frequent execution. To demonstrate the broad applicability of SPM, more diverse and complex procedures need to be studied. The aim of this study is to investigate the accuracy in which we can recognise and extract surgical phases in laparoscopic hysterectomies (LHs) with inherent variability in procedure time. To show the applicability of the approach, the model was used to automatically predict surgical end-times. Methods A dataset of 40 video-recorded LHs was manually annotated for instrument use and divided into ten surgical phases. The use of instruments provided the feature input for building a Random Forest surgical phase recognition model that was trained to automatically recognise surgical phases. Tenfold cross-validation was performed to optimise the model for predicting the surgical end-time throughout the procedure. Results Average surgery time is 128 ± 27 min. Large variability within specific phases is seen. Overall, the Random Forest model reaches an accuracy of 77% recognising the current phase in the procedure. Six of the phases are predicted accurately over 80% of their duration. When predicting the surgical end-time, on average an error of 16 ± 13 min is reached throughout the procedure. Conclusions This study demonstrates an intra-operative approach to recognise surgical phases in 40 laparoscopic hysterectomy cases based on instrument usage data. The model is capable of automatic detection of surgical phases for generation of a solid prediction of the surgical end-time.
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Affiliation(s)
- F C Meeuwsen
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - F van Luyn
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - M D Blikkendaal
- Department of Gynecology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - F W Jansen
- Department of Gynecology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J J van den Dobbelsteen
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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14
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Kreuninger JA, Cohen SL, Meurs EAIM, Cox M, Vitonis A, Jansen FW, Einarsson JI. Trends in readmission rate by route of hysterectomy - a single-center experience. Acta Obstet Gynecol Scand 2017; 97:285-293. [PMID: 29192965 DOI: 10.1111/aogs.13270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/12/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The aim of this study was to assess the 60-day readmission rates after hysterectomy according to route of surgery and analyze risk factors for postoperative readmission. MATERIAL AND METHODS This retrospective study included all women who underwent hysterectomy due to benign conditions from 2009 to 2015 at a large academic center in Boston. Readmission rates were compared among the following four types of hysterectomies: abdominal, laparoscopic, robotic and vaginal. RESULTS There were 3981 hysterectomy cases over the study period (628 abdominal hysterectomy, 2500 laparoscopic hysterectomy, 155 robotic hysterectomy and 698 vaginal hysterectomy). Intraoperative complications occurred more frequently in women undergoing abdominal hysterectomy (4.8%), followed by robotic hysterectomy (3.9%), vaginal hysterectomy (1.9%) and laparoscopic hysterectomy (1.6%) (p < 0.0001). Readmission rates were not significantly different among the groups; women receiving abdominal hysterectomy had an overall readmission rate of 3.5%, compared with 3.2% after robotic hysterectomy, 2.9% after vaginal hysterectomy and 1.9% after laparoscopic hysterectomy (p = 0.06). When stratifying for relevant variables, women who had an laparoscopic hysterectomy had a twofold reduction of readmission compared with abdominal hysterectomy (odds ratio 0.52, 95% confidence interval 0.31-0.87; p = 0.01). There was no significant difference in readmission when robotic hysterectomy or vaginal hysterectomy were compared individually with abdominal hysterectomy. Regarding risk factors related to readmission it was observed that perioperative complications were the largest driver of readmissions (odds ratio 667, 95% confidence interval 158-99; p < 0.0001). CONCLUSION The laparoscopic approach to hysterectomy was associated with fewer hospital readmissions compared with the abdominal route; vaginal, robotic and abdominal approaches had a similar risk of readmission. Perioperative complications represent the main driver of readmissions. After adjusting for perioperative factors such as surgeon type and complications, no difference in readmissions between the different routes of hysterectomy were found.
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Affiliation(s)
- Jennifer A Kreuninger
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Division of Minimally Invasive Gynecologic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Elsemieke A I M Meurs
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary Cox
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Allison Vitonis
- Department of Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank W Jansen
- Division of Minimally Invasive Gynecologic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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van Hoogenhuijze NE, Torrance HL, Mol F, Laven JSE, Scheenjes E, Traas MAF, Janssen C, Cohlen B, Teklenburg G, de Bruin JP, van Oppenraaij R, Maas JWM, Moll E, Fleischer K, van Hooff MH, de Koning C, Cantineau A, Lambalk CB, Verberg M, Nijs M, Manger AP, van Rumste M, van der Voet LF, Preys-Bosman A, Visser J, Brinkhuis E, den Hartog JE, Sluijmer A, Jansen FW, Hermes W, Bandell ML, Pelinck MJ, van Disseldorp J, van Wely M, Smeenk J, Pieterse QD, Boxmeer JC, Groenewoud ER, Eijkemans MJC, Kasius JC, Broekmans FJM. Endometrial scratching in women with implantation failure after a first IVF/ICSI cycle; does it lead to a higher live birth rate? The SCRaTCH study: a randomized controlled trial (NTR 5342). BMC Womens Health 2017; 17:47. [PMID: 28732531 PMCID: PMC5521151 DOI: 10.1186/s12905-017-0378-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Success rates of assisted reproductive techniques (ART) are approximately 30%, with the most important limiting factor being embryo implantation. Mechanical endometrial injury, also called 'scratching', has been proposed to positively affect the chance of implantation after embryo transfer, but the currently available evidence is not yet conclusive. The primary aim of this study is to determine the effect of endometrial scratching prior to a second fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle on live birth rates in women with a failed first IVF/ICSI cycle. METHOD Multicenter randomized controlled trial in Dutch academic and non-academic hospitals. A total of 900 women will be included of whom half will undergo an endometrial scratch in the luteal phase of the cycle prior to controlled ovarian hyperstimulation using an endometrial biopsy catheter. The primary endpoint is the live birth rate after the 2nd fresh IVF/ICSI cycle. Secondary endpoints are costs, cumulative live birth rate (after the full 2nd IVF/ICSI cycle and over 12 months of follow-up); clinical and ongoing pregnancy rate; multiple pregnancy rate; miscarriage rate and endometrial tissue parameters associated with implantation failure. DISCUSSION Multiple studies have been performed to investigate the effect of endometrial scratching on live birth rates in women undergoing IVF/ICSI cycles. Due to heterogeneity in both the method and population being scratched, it remains unclear which group of women will benefit from the procedure. The SCRaTCH trial proposed here aims to investigate the effect of endometrial scratching prior to controlled ovarian hyperstimulation in a large group of women undergoing a second IVF/ICSI cycle. TRIAL REGISTRATION NTR 5342 , registered July 31st, 2015. PROTOCOL VERSION Version 4.10, January 4th, 2017.
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Affiliation(s)
- N E van Hoogenhuijze
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - H L Torrance
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F Mol
- Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J S E Laven
- Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E Scheenjes
- Gelderse Vallei Hospital, Ede, The Netherlands
| | | | - C Janssen
- Groene Hart Hospital, Gouda, The Netherlands
| | - B Cohlen
- Isala Fertilityclinic, Zwolle, The Netherlands
| | | | - J P de Bruin
- Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | | | - J W M Maas
- Maxima Medical Center, Veldhoven, The Netherlands
| | - E Moll
- Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - K Fleischer
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - C de Koning
- Ter Gooi Hospital, Hilversum, The Netherlands
| | - A Cantineau
- University Medical Center Groningen, Groningen, The Netherlands
| | - C B Lambalk
- Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - M Verberg
- Fertility Clinic Twente, Hengelo, The Netherlands
| | - M Nijs
- Nij Geertgen, Elsendorp, The Netherlands
| | - A P Manger
- Diakonessenhuis, Utrecht, The Netherlands
| | | | | | | | - J Visser
- Amphia Hospital, Breda, The Netherlands
| | - E Brinkhuis
- Meander Medical Center, Amersfoort, The Netherlands
| | - J E den Hartog
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Sluijmer
- Wilhelmina Hospital Assen, Assen, The Netherlands
| | - F W Jansen
- Leiden University Medical Center, Leiden, The Netherlands
| | - W Hermes
- Medical Center Haaglanden-Bronovo-Nebo, The Hague, The Netherlands
| | - M L Bandell
- Albert Schweitzer Hospital, Sliedrecht, The Netherlands
| | | | | | - M van Wely
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynecology - NVOG Consortium 2.0, Dutch, The Netherlands
| | - J Smeenk
- St. Elisabeth-Twee Steden Hospital, Tilburg, The Netherlands
| | | | - J C Boxmeer
- Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - M J C Eijkemans
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J C Kasius
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F J M Broekmans
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Sandberg EM, Leinweber FS, de Vos MS, Linthorst J, Holman FA, Twijnstra ARH, Jansen FW. [Optimising postoperative recovery at home; individualised discharge policy and task division between GP and medical specialist]. Ned Tijdschr Geneeskd 2017; 161:D1672. [PMID: 29098970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the last decennia, the length of hospital stay of admitted patients has significantly decreased in all medical fields. As a result, postoperative recovery mainly takes place at home, inherently leading to new challenges. Here, two patients are being discussed for whom the postoperative period was substandard. To guarantee optimal quality of care in the home situation, the medical specialist and the general practitioner need to make the necessary arrangements. We would first of all recommend providing each discharged patient with specific, structured and individualised advices regarding postoperative recovery but also regarding alarm symptoms and logistics (e.g. who to call in case of emergency). Finally, we believe that, as (serious) complications are rare, it should be agreed on the fact that the responsible medical specialist is the coordinator of the postoperative period and the first contact point for postoperative patients.
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Lier MCI, Malik RF, van Waesberghe JHTM, Maas JW, van Rumpt-van de Geest DA, Coppus SF, Berger JP, van Rijn BB, Janssen PF, de Boer MA, de Vries JIP, Jansen FW, Brosens IA, Lambalk CB, Mijatovic V. Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series. BJOG 2016; 124:306-312. [DOI: 10.1111/1471-0528.14371] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- MCI Lier
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - RF Malik
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - JHTM van Waesberghe
- Department of Radiology; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - JW Maas
- Department of Obstetrics & Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | | | - SF Coppus
- Department of Obstetrics & Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - JP Berger
- Department of Obstetrics & Gynaecology; Bronovo Hospital; Den Haag the Netherlands
| | - BB van Rijn
- Department of Obstetrics; Wilhelmina Children's Hospital Birth Centre; University Medical Centre Utrecht; Utrecht the Netherlands
- Academic Unit Human Development and Health; Institute for Life Sciences; University of Southampton; Southampton UK
| | - PF Janssen
- Department of Obstetrics & Gynaecology; St. Elisabeth Hospital; Tilburg the Netherlands
| | - MA de Boer
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - JIP de Vries
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - FW Jansen
- Department of Obstetrics & Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - IA Brosens
- Leuven Institute for Fertility and Embryology; Leuven Belgium
| | - CB Lambalk
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
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Sandberg EM, Cohen SL, Jansen FW, Einarsson JI. Laparoscopic Myomectomy as a New Standard: An Analysis of Risk Factors for Conversion. J Minim Invasive Gynecol 2016; 22:S62. [PMID: 27679293 DOI: 10.1016/j.jmig.2015.08.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E M Sandberg
- Gynaecology, Leiden University Medical Center, Leiden, Zuid Holland, Netherlands
| | - S L Cohen
- Gynaecology (Minimally Invasive Surgery), Brigham and Women's Hospital, Boston, Massachusetts
| | - F W Jansen
- Gynaecology, Leiden University Medical Center, Leiden, Zuid Holland, Netherlands
| | - J I Einarsson
- Gynaecology (Minimally Invasive Surgery), Brigham and Women's Hospital, Boston, Massachusetts
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19
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Sandberg EM, van den Haak L, Bosse T, Jansen FW. Disseminated leiomyoma cells can be identified following conventional myomectomy. BJOG 2016; 123:2183-2187. [DOI: 10.1111/1471-0528.14265] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 12/27/2022]
Affiliation(s)
- EM Sandberg
- Department of Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - L van den Haak
- Department of Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - T Bosse
- Department of Pathology; Leiden University Medical Centre; Leiden the Netherlands
| | - FW Jansen
- Department of Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
- Department of BioMechanical Engineering; Delft University of Technology; Delft the Netherlands
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20
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Driessen S, Rodrigues SP, Twijnstra A, Jansen FW. Quantification of Safety Risk Factors in Laparoscopic Hysterectomy: A Prospective International Multicentre Study. J Minim Invasive Gynecol 2015; 22:S202-S203. [PMID: 27679039 DOI: 10.1016/j.jmig.2015.08.732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Src Driessen
- Leiden University Medical Center, Leiden, New York, Netherlands
| | - S P Rodrigues
- Leiden University Medical Center, Leiden, New York, Netherlands
| | - Arh Twijnstra
- Leiden University Medical Center, Leiden, New York, Netherlands
| | - F W Jansen
- Leiden University Medical Center, Leiden, New York, Netherlands
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21
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Sandberg EM, Twijnstra ARH, Jansen FW. Laparoscopic Hysterectomy: Dos and Don’ts. J Minim Invasive Gynecol 2015; 22:S207. [DOI: 10.1016/j.jmig.2015.08.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Janse JA, Driessen SRC, Veersema S, Broekmans FJM, Jansen FW, Schreuder HWR. Training of hysteroscopic skills in residency program: the Dutch experience. J Surg Educ 2015; 72:345-350. [PMID: 25439181 DOI: 10.1016/j.jsurg.2014.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/24/2014] [Accepted: 09/09/2014] [Indexed: 06/04/2023]
Abstract
STUDY OBJECTIVE To evaluate whether hysteroscopy training in the Dutch gynecological residency program is judged as sufficient in daily practice, by assessment of the opinion on hysteroscopy training and current performance of hysteroscopic procedures. In addition, the extent of progress in comparison with that of the residency program of a decade ago is reviewed. DESIGN Survey (Canadian Task Force Classification III). PARTICIPANTS Postgraduate years 5 and 6 residents in obstetrics and gynecology and gynecologists who finished residency within 2008 to 2013 in the Netherlands. INTERVENTION Subjects received an online survey regarding performance and training of hysteroscopy, self-perceived competence, and hysteroscopic skills acquirement. RESULTS Response rate was 65% of the residents and 73% of the gynecologists. Most residents felt adequately prepared for basic hysteroscopic procedures (86.7%), but significantly less share this opinion for advanced procedures (64.5%) (p < 0.01). In comparison with their peers in 2003, the current residents demonstrated a 10% higher appreciation of the training curriculum. However, their self-perceived competence did not increase, except for diagnostic hysteroscopy. Regarding daily practice, not only do more gynecologists perform advanced procedures nowadays but also their competence level received higher scores in comparison with gynecologists in 2003. Lack of simulation training was indicated to be the most important factor during residency that could be enhanced for optimal acquirement of hysteroscopic skills. CONCLUSION Implementation of hysteroscopic procedures taught during residency training in the Netherlands has improved since 2003 and is judged as sufficient for basic procedures. The skills of surgical educators have progressed toward a level in which gynecologists feel competent to teach and supervise advanced hysteroscopic procedures. Even though the residency preparation for hysteroscopy is more highly appreciated than a decade ago, this study indicated that simulation training might serve as an additional method to improve hysteroscopic skills acquisition. Future research is needed to determine the value of simulation training in hysteroscopy.
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Affiliation(s)
- Juliënne A Janse
- Department of Gynecology & Obstetrics, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Veersema
- Department of Gynecology & Obstetrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Frank J M Broekmans
- Division of Woman & Baby, Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank W Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk W R Schreuder
- Division of Woman & Baby, Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Rodrigues SP, van Eck NJ, Waltman L, Jansen FW. Mapping patient safety: a large-scale literature review using bibliometric visualisation techniques. BMJ Open 2014; 4:e004468. [PMID: 24625640 PMCID: PMC3963077 DOI: 10.1136/bmjopen-2013-004468] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/04/2014] [Accepted: 02/17/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The amount of scientific literature available is often overwhelming, making it difficult for researchers to have a good overview of the literature and to see relations between different developments. Visualisation techniques based on bibliometric data are helpful in obtaining an overview of the literature on complex research topics, and have been applied here to the topic of patient safety (PS). METHODS On the basis of title words and citation relations, publications in the period 2000-2010 related to PS were identified in the Scopus bibliographic database. A visualisation of the most frequently cited PS publications was produced based on direct and indirect citation relations between publications. Terms were extracted from titles and abstracts of the publications, and a visualisation of the most important terms was created. The main PS-related topics studied in the literature were identified using a technique for clustering publications and terms. RESULTS A total of 8480 publications were identified, of which the 1462 most frequently cited ones were included in the visualisation. The publications were clustered into 19 clusters, which were grouped into three categories: (1) magnitude of PS problems (42% of all included publications); (2) PS risk factors (31%) and (3) implementation of solutions (19%). In the visualisation of PS-related terms, five clusters were identified: (1) medication; (2) measuring harm; (3) PS culture; (4) physician; (5) training, education and communication. Both analysis at publication and term level indicate an increasing focus on risk factors. CONCLUSIONS A bibliometric visualisation approach makes it possible to analyse large amounts of literature. This approach is very useful for improving one's understanding of a complex research topic such as PS and for suggesting new research directions or alternative research priorities. For PS research, the approach suggests that more research on implementing PS improvement initiatives might be needed.
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Affiliation(s)
- S P Rodrigues
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - N J van Eck
- Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands
| | - L Waltman
- Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands
| | - F W Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Twijnstra ARH, Blikkendaal MD, van Zwet EW, Jansen FW. Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol 2013; 20:64-72. [PMID: 23312244 DOI: 10.1016/j.jmig.2012.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVES To estimate the current conversion rate in laparoscopic hysterectomy (LH); to estimate the influence of patient, procedure, and performer characteristics on conversion; and to hypothesize the extent to which conversion rate can act as a means of evaluation in LH. DESIGN Prospective cohort study (Canadian Task Force classification II-2). SETTING The study included 79 gynecologists representing 42 hospitals throughout the Netherlands. This reflects 75% of all gynecologists performing LH in the Netherlands, and 68% of all hospitals. PATIENTS Data from 1534 LH procedures were collected between 2008 and 2010. INTERVENTION All participants in the nationwide LapTop registration study recorded each consecutive LH they performed during 1 year. MEASUREMENTS AND MAIN RESULTS Conversion rate and odds ratios (OR) of risk factors for conversion were calculated. Conversions were described as reactive or strategic. The literature reported a conversion rate for LH of 0% to 19% (mean, 3.5%). In our cohort, 70 LH procedures (4.6%) were converted. Using a mixed-effects logistic regression model, we estimated independent risk factors for conversion. Body mass index (BMI) (p = .002), uterus weight (p < .001), type of LH (p = .004), and age (p = .02) had a significant influence on conversion. The risk of conversion was increased at BMI >35 (OR, 6.53; p < .001), age >65 years (OR, 6.97; p = .007), and uterus weight 200 to 500 g (OR, 4.05; p < .001) and especially >500 g (OR, 30.90; p < .001). A variation that was not explained by the covariates included in our model was identified and referred to as the "surgical skills factor" (average OR, 2.79; p = .001). CONCLUSION Use of estimated risk factors (BMI, age, uterus weight, and surgical skills) provides better insight into the risk of conversion. Conversion rate can be used as a means of evaluation to ensure better outcomes of LH in future patients.
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25
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van de Berg NJ, van den Dobbelsteen JJ, Jansen FW, Grimbergen CA, Dankelman J. Energetic soft-tissue treatment technologies: an overview of procedural fundamentals and safety factors. Surg Endosc 2013; 27:3085-99. [PMID: 23572215 DOI: 10.1007/s00464-013-2923-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/25/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Energy administered during soft-tissue treatments may cauterize, coagulate, seal, or otherwise affect underlying structures. A general overview of the functionality, procedural outcomes, and associated risks of these treatments, however, is not yet generally available. In addition, literature is sometimes inconsistent with regards to terminology. Along with the rapid expansion of available energetic instruments, particularly in the field of endoscopic surgery, these factors may complicate the ability to step back, review available treatment options, and identify critical parameters for appropriate use. METHODS Online databases of PubMed, Web of Science, and Google Scholar were used to collect literature on popular energetic treatments, such as electrosurgery, plasma surgery, ultrasonic surgery, and laser surgery. The main results include review and comparison studies on the working mechanisms, pathological outcomes, and procedural hazards. RESULTS The tissue response to energetic treatments can be largely explained by known mechanical and thermal interactions. Application parameters, such as the interaction time and power density, were found to be of major influence. By breaking down treatments to this interaction level, it is possible to differentiate the available options and reveal their strengths and weaknesses. Exact measures of damage and alike quantifications of interaction are, although valuable to the surgeon, often either simply unknown due to the high impact of tissue and application-dependent parameters or badly documented in previous studies. In addition, inconsistencies in literature regarding the terminology of used techniques were observed and discussed. They may complicate the formulation of cause and effect relations and lead to misconceptions regarding the treatment performance. CONCLUSIONS Some basic knowledge on used energetic treatments and settings and a proper use of terminology may enhance the practitioner's insight in allowable actions to take, improve the interpretation and diagnosis of histological and mechanical tissue changes, and decrease the probability of iatrogenic mishaps.
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Affiliation(s)
- N J van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, 3mE, Mekelweg 2, 2628 CD Delft, The Netherlands.
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Horeman T, Jansen FW, Dankelman J. The MSIS Trocar; An Isolator System for Laparoscopic Surgery. J Med Device 2012. [DOI: 10.1115/1.4026701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - J Dankelman
- Delft University of Technology, The Netherlands
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Jansen FW, Hiemstra E. Laparoscopic skills training using inexpensive box trainers: which exercises to choose when constructing a validated training course. BJOG 2012; 119:263-5. [PMID: 22239414 DOI: 10.1111/j.1471-0528.2011.03143.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F W Jansen
- Section Minimally Invasive Surgery in Gynecology, Leiden University Medical Centre, Leiden, The Netherlands.
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Twijnstra ARH, Zeeman GG, Jansen FW. A novel approach to registration of adverse outcomes in obstetrics and gynaecology: a feasibility study. Qual Saf Health Care 2011; 19:132-7. [PMID: 20351161 DOI: 10.1136/qshc.2008.030833] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The central aim of this study was to assess the feasibility of the developed adverse outcome registration method. Furthermore, it was tested whether the information gathered through the registration system allowed for comparative analyses. DESIGN Prospective observational multicentre study. SETTING The obstetrics and gynaecology departments of three Dutch university and three general hospitals. Population Every consecutive admission to these departments during the 12-month study period. METHODS All complications, during admission and up to 6 weeks after discharge, were registered using a standardised form. The complication type and origin were noted and the severity of the complications were graded. MAIN OUTCOME MEASURES The differences in relative frequencies of complications between the participating university and general hospitals. RESULTS A total of 10 470 admissions were observed at the obstetrics and gynaecology departments of the six hospitals combined. The standard complication registration form was completed for approximately 90% of these admissions. A total of 351 gynaecological (9.1%) and 960 obstetrical (14.5%) complications were reported. There was no significant difference in the percentage of complications between general hospitals and university hospitals. The severity of complications, however, varied significantly between the participating hospitals. CONCLUSIONS A feasible framework for complication registration in the field of obstetrics and gynaecology has been developed. Before comparing frequencies of adverse events between hospitals, such outcome measures first need to be risk-adjusted to overcome the problem of patient variation and acuity between hospitals as a source of difference, leaving quality of care as a primary source of variation.
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Affiliation(s)
- A R H Twijnstra
- Leids Universitair Medisch Centrum, K-6-P, Room No 76, PO Box 9600, 2300 RC Leiden, The Netherlands
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Abstract
Ergonomic problems of surgical lighting systems have been indicated by surgeons; however, the underlying causes are not clear. The aim of this study is to assess the problems in detail. Luminaire use during 46 hours of surgery was observed and quantified. Furthermore, a questionnaire on perceived illumination of and usability problems with surgical luminaires was issued among OR-staff in 13 hospitals. The results showed that every 7.5 minutes a luminaire action (LA) takes place, intended to reposition the luminaire. Of these LAs, 74% were performed by surgeons and residents. For 64% of these LAs the surgical tasks of the OR-staff were interrupted. The amount of LAs to obtain a well-lit wound, the illumination level, shadows, and the illumination of deep wounds were most frequently indicated lighting aspects needing improvement. Different kinematic aspects of the pendant system of the lights that influence usability were also mentioned: High forces for repositioning, ease of focusing and aiming, ease of moving, collisions of the luminaire, entangling of pendant arms, and maneuverability. Based on these results conclusions regarding the improvement of surgical lighting systems are formulated. Focus for improvements should be on minimizing the need for repositioning the luminaire, and on minimizing the effort for repositioning.
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Affiliation(s)
- Arjan J Knulst
- Delft University of Technology, Dept. of BioMechanical Engineering , Delft , The Netherlands.
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Gahler MMC, van de Berg NNJ, Rhemrev J, Jansen FW, van den Dobbelsteen J. Vaginal Approach for Uterus Separation During Laparoscopic Hysterectomy. J Med Device 2010. [DOI: 10.1115/1.3442765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Every year more than 15.000 total hysterectomy procedures are performed in the Netherlands. From all these procedures, only a minor part is done via a laparoscopic approach. One reason for this is the high complexity of the procedure. The uterus is difficult to reach with the laparoscopic tools and nearby structures are easily damaged. Especially, the separation of the uterus at the fornix needs to be done with great care and is time consuming (i.e., typically takes more than 15–20 min). This results in long procedure times. To resolve part of these difficulties, a new instrument has been designed that enables separation of the uterus via a vaginal approach. The device uses a cutting mechanism to safely separate the uterus from the vagina wall. The design allows the application of an existing manipulator to mobilize the uterus for better access of laparoscopic tools. A prototype of the separation tool, MobiSep, has been manufactured. The new separation principle has been evaluated in a test setup. Over the device a tubular piece of tissue was mounted, resembling the vagina wall. The results show that the time needed for full separation is on average 102 (s). The maximum driving force needed to cut the tissue is found to be 50 (N), which can be applied manually. It is expected that this prototype is intuitive to use, can contribute to the reduction of the complexity of laparoscopic hysterectomy procedures and can reduce the total procedure time.
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Knulst AJ, Mooijweer R, Jansen FW, Stassen LPS, Dankelman J. Indicating Shortcomings in Surgical Lighting Systems. J Med Device 2010. [DOI: 10.1115/1.3442440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ergonomic problems of surgical lighting systems have been indicated by surgeons. However, the underlying causes are not clear. The aim of this study is to assess the problems in detail. Luminaire use during 46 h of surgery was observed and quantified. Furthermore, a questionnaire on perceived illumination of and usability problems with surgical luminaires was issued among OR-staff in 13 hospitals. The results showed that every 7.5 min a luminaire action (LA) takes place, intended to reposition the luminaire. Of these LAs, 74% was performed by surgeons and residents. For 64% of these LAs the surgical tasks of OR-staff were interrupted. The amount of LAs to obtain a well-lit wound, illumination level, shadows, and illumination of deep wounds were most frequently indicated lighting aspects needing improvement. Different kinematic aspects of the pendant system of the lights that influence usability were also mentioned: high forces for repositioning, ease of focusing and aiming, ease of moving, collisions of the luminaire, entangling of pendant arms, and maneuverability. Based on these results, conclusions regarding to improvement of surgical lighting systems are formulated. Focus for improvements should be on minimizing the need for repositioning the luminaire, and on minimizing the effort for repositioning.
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van Dongen H, Janssen CAH, Smeets MJGH, Emanuel MH, Jansen FW. The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding. BJOG 2009; 116:1387-90. [DOI: 10.1111/j.1471-0528.2009.02145.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jansen FW, van Dongen H. [Hysteroscopy: useful in diagnosis and surgical treatment of intrauterine lesions]. Ned Tijdschr Geneeskd 2008; 152:1961-1966. [PMID: 18807332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hysteroscopic surgery has an established role in the field of gynaecologic surgery. With the introduction of thinner scopes and simpler instruments part of the interventions can now be performed on an outpatient basis. Hysteroscopy can be used for the removal of polyps and myomas, endometrial resection, synechiolysis, sterilisation, septum resection and the removal of remnants from pregnancy. Hysteroscopic surgery can be an option for patients who wish to preserve the uterus and for the treatment of infertility. The complication rate associated with hysteroscopic interventions is low. The most common events are intravasation of distension fluid, uterine perforation, and haemorrhage. The complication rate depends on the complexity of the procedure.
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Affiliation(s)
- F W Jansen
- Leids Universitair Medisch Centrum, afd. Gynaecologie, Leiden.
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van Dongen H, de Kroon CD, van den Tillaart SAHM, Louwé LA, Trimbos-Kemper GCM, Jansen FW. A randomised comparison of vaginoscopic office hysteroscopy and saline infusion sonography: a patient compliance study. BJOG 2008; 115:1232-7. [DOI: 10.1111/j.1471-0528.2008.01858.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Timmermans A, Gerritse MBE, Opmeer BC, Jansen FW, Mol BWJ, Veersema S. Diagnostic accuracy of endometrial thickness to exclude polyps in women with postmenopausal bleeding. J Clin Ultrasound 2008; 36:286-290. [PMID: 18004723 DOI: 10.1002/jcu.20415] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To determine the accuracy of endometrial thickness measurement with transvaginal ultrasonography (TVUS) to diagnose endometrial polyps in women with postmenopausal bleeding in whom a carcinoma has been ruled out. METHODS In women with postmenopausal bleeding, endometrial thickness was measured with TVUS. If endometrial thickness was >4 mm, office hysteroscopy was performed. At hysteroscopy, the uterine cavity was assessed for the presence of polyps. Patients with malignancy were excluded. We used receiver operating characteristics (ROC) analysis to assess the capacity of TVUS endometrial thickness measurement to diagnose endometrial polyps. Findings at hysteroscopy were considered to be the reference standard. RESULTS We included 178 patients with postmenopausal bleeding and endometrial thickness >4 mm. Hysteroscopy showed an endometrial polyp in 90 patients (50%). The ROC analysis revealed that endometrial thickness had an area under the curve of 0.64 in the diagnosis of endometrial polyps. CONCLUSION In women with postmenopausal bleeding in whom carcinoma has been ruled out, measurement of endometrial thickness with TVUS is not useful in the diagnosis of endometrial polyps.
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Affiliation(s)
- Anne Timmermans
- Department of Perinatology and Gynecology, University Medical Centre Utrecht, 3508 AB Utrecht, POB 85090, The Netherlands
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Middeldorp JM, Lopriore E, Sueters M, Jansen FW, Ringers J, Klumper FJCM, Oepkes D, Vandenbussche FPHA. Laparoscopically Guided Uterine Entry for Fetoscopy in Twin-to-Twin Transfusion Syndrome with Completely Anterior Placenta: A Novel Technique. Fetal Diagn Ther 2007; 22:409-15. [PMID: 17652926 DOI: 10.1159/000106344] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 08/10/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Laser coagulation of anastomotic vessels on the placental surface is the treatment of choice in severe second trimester twin-to-twin transfusion syndrome (TTTS). This procedure is associated with technical difficulties when the placenta is located on the anterior side of the uterus. We describe a novel technique for fetoscopy in TTTS with completely anterior placenta where laparoscopy is used to guide safe percutaneous insertion of the fetoscope through the lateral abdominal wall and the dorsal side of the uterus. METHODS Prospective controlled series of 16 TTTS pregnancies with completely anterior placenta (study group) treated with this novel technique. Studied outcomes were technical result of the procedure and perinatal survival. Outcome in the study group was compared with outcome of 49 TTTS pregnancies treated with conventional percutaneous fetoscopic laser without laparoscopy, 9 of these with partially anterior placenta (control group A) and 40 with lateral or posterior placenta (control group B). RESULTS In the study group, the procedure-related complication rate was 25% (4/16). In 1 case, uterine entry of the fetoscope from the lateral abdominal wall was not possible due to complex bowel adhesions. In 3 patients, intra-amniotic haemorrhage occurred after fetoscopic entry, preventing complete laser coagulation of anastomoses. One of these patients required 2 units of blood transfusion. The procedure-related complication rate in control groups A and B was 22% (2/9) and 5% (2/40), respectively (intra-amniotic haemorrhage n = 3, severe leakage of amniotic fluid into the peritoneal cavity, n = 1). Perinatal survival in the study group, control group A and control group B was 63% (20/32), 78% (14/18) and 70% (56/80), respectively. CONCLUSION Combined laparoscopy and fetoscopy is a novel technique that enables safe uterine entry and creates optimal visualisation for laser coagulation of inter-twin anastomoses in TTTS pregnancies with completely anterior placenta. The procedure-related complication rate and perinatal survival rate were similar compared to the conventional percutaneous technique. Procedure-related complications occur more often with partially or completely anterior placenta.
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Affiliation(s)
- Johanna M Middeldorp
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
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Abstract
BACKGROUND This study was conducted to assess the accuracy and feasibility of diagnostic hysteroscopy in the evaluation of intrauterine abnormalities in women with abnormal uterine bleeding. SEARCH STRATEGY Electronic databases were searched from 1 January 1965 to 1 January 2006 without language selection. The medical subject heading (MeSH) and textwords for the following terms were used: hysteroscopy, diagnosis, histology, histopathology, hysterectomy, biopsy, sensitivity and specificity. SETTING University Hospital. SELECTION CRITERIA The inclusion criteria were report on accuracy of diagnostic hysteroscopy in women with abnormal uterine bleeding compared to histology collected with guided biopsy during hysteroscopy, operative hysteroscopy or hysterectomy. DATA COLLECTION AND ANALYSIS Electronic databases were searched for relevant studies and references were cross-checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated and data were pooled. Subgroup analysis was performed according to validity criteria, study quality, menopausal state, time, setting and performance of the procedure. The pooled sensitivity, specificity, likelihood ratios, post-test probabilities and feasibility of diagnostic hysteroscopy on the prediction of uterine cavity abnormalities. Post-test probabilities were derived from the likelihood ratios and prevalence of intrauterine abnormalities among included studies. Feasibility included technical success rate and complication rate. MAIN RESULTS One population of homogeneous data could be identified, consisting of patients with postmenopausal bleeding. In this subgroup the positive and negative likelihood ratios were 7.9 (95% CI 4.79-13.10) and 0.04 (95% CI 0.02-0.09), raising the pre-test probability from 0.61 to a post-test probability of 0.93 (95% CI 0.88-0.95) for positive results and reducing it to 0.06 (95% CI 0.03-0.13) for negative results. The pooled likelihood ratios of all studies included, calculated with the random effects model, were 6.5 (95% CI 4.1-10.4) and 0.08 (95% CI 0.07-0.10), changing the pre-test probability of 0.46 to post-test probabilities of 0.85 (95% CI 0.78-0.90) and 0.07 (0.06-0.08) for positive and negative results respectively. Subgroup analyses gave similar results. The overall success rate of diagnostic hysteroscopy was estimated at 96.9% (SD 5.2%, range 83-100%). CONCLUSIONS This systematic review and meta-analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities.
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Affiliation(s)
- H van Dongen
- Department of Gynaecology, Leiden Unviersity Medical Center, Leiden, The Netherlands.
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Chmarra MK, Kolkman W, Jansen FW, Grimbergen CA, Dankelman J. The influence of experience and camera holding on laparoscopic instrument movements measured with the TrEndo tracking system. Surg Endosc 2007; 21:2069-75. [PMID: 17479335 DOI: 10.1007/s00464-007-9298-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Revised: 12/23/2006] [Accepted: 01/13/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eye-hand coordination problems occur during laparoscopy. This study aimed to investigate the difference in instrument movements between the surgeon him- or herself holding the camera and an assistant holding the camera during performance of a laparoscopic task and to check whether experience of the surgeon plays a role in this issue. METHODS The participants were divided into three groups: experts, residents, and novices. Each participant performed positioning tasks using the right (R) and left (L) hands. During these tasks, the camera was manipulated either by the participant (C(self)) or by an assistant (C(assistant)). Movements of instruments were recorded with the authors' new TrEndo tracking system. The performance was analyzed using five kinematic parameters: time, path length, three-dimensional (3D) motion smoothness, 1D motion smoothness (along the axis), and depth perception. RESULTS A total of 46 participants contributed. Three tests were performed: test 1-LC(self), test 2-LC(assistant), and test 3-RC(assistant). In all the tests, the experts performed better than the residents and novices in terms of time, path length, and depth perception. The novices performed better in tests 1-LC(self) and 2-LC(assistant) than in test 3-RC(assistant) in terms of path length, 3D motion smoothness, and depth perception. CONCLUSIONS Laparoscopic experience and the camera-holding factor influenced the performance of laparoscopic tasks on the simulator. Time, path length, and depth perception clearly discriminate between different levels of experience in laparoscopy, whereas 3D and 1D motion smoothness play a limited role. Novices experienced more difficulties when an assistant held the camera. Therefore, self-manipulation of the camera seems to improve novices' eye-hand coordination.
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Affiliation(s)
- M K Chmarra
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
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Weijenborg PT, ter Kuile MM, Jansen FW. Intraobserver and interobserver reliability of videotaped laparoscopy evaluations for endometriosis and adhesions. Fertil Steril 2007; 87:373-80. [DOI: 10.1016/j.fertnstert.2006.06.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2005] [Revised: 06/23/2006] [Accepted: 06/23/2006] [Indexed: 11/16/2022]
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Kolkman W, Van de Put MAJ, Van den Hout WB, Trimbos JBMZ, Jansen FW. Implementation of the laparoscopic simulator in a gynecological residency curriculum. Surg Endosc 2006; 21:1363-8. [PMID: 17165113 DOI: 10.1007/s00464-006-9120-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 07/04/2006] [Accepted: 07/28/2006] [Indexed: 01/05/2023]
Abstract
BACKGROUND In view of the current emphasis on increasing patient safety and quality control in laparoscopic surgery, there is a growing need to improve laparoscopic training. This study was conducted to investigate if and when residents reached performance standards for basic laparoscopic skills on a boxtrainer and to analyze the current state of implementation of laparoscopic simulators in a gynecological residency curriculum. METHODS Residents across all 6 years of residency (postgraduate year [PGY] 1-6) were tested once on our boxtrainer by performing five inanimate tasks (pipe cleaner, rubber band, beads, cutting circle, intracorporeal knot tying). A sumscore for the five tasks was calculated for each participant (sum of all scores). Scores were calculated by adding completion time and penalty points, thus rewarding both speed and precision. These data were compared with scores of laparoscopic experts, which were set as performance standards. RESULTS Of the participants, 111 were residents (7 PGY1, 27 PGY2, 29 PGY3, 28 PGY4, 14 PGY5, 6 PGY6) and 8 were experts. At the end of residency, PGY6 residents reached the performance standard for all tasks except intracorporeal knot tying. It was not until PGY5 that residents reached the performance standard for the pipe cleaner task; PGY1, for rubber band; PGY5, for beads; PGY4, for circle cutting; and PGY6, for sumscore. Throughout residency PGY6 had a mean total of only 3.6 h of simulator training experience. No correlation was found between this previous voluntary simulator training experience and performance on our boxtrainer during this study (sumscore), and between previous voluntary simulator training and total laparoscopic procedures performed. In a combined multivariate analysis, sumscore performance remained significantly associated with the number of laparoscopic procedures performed by residents when they were working as as a primary surgeon (p = 0.002), and not with the cumulative hours of simulator training during residency prior to participating in this study (p = 0.15). CONCLUSIONS In a current Dutch gynecological residency curriculum, residents do not reach all performance standards for basic laparoscopic skills on the boxtrainer. We conclude that the voluntary simulator training program has a substantial risk to fail and that the implementation of the laparoscopic skills simulator in the current residency curriculum is in its infancy.
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Affiliation(s)
- W Kolkman
- Department of Gynecology, Leiden University Medical Center K6-76, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
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Gaarenstroom KN, van der Hiel B, Tollenaar RAEM, Vink GR, Jansen FW, van Asperen CJ, Kenter GG. Efficacy of screening women at high risk of hereditary ovarian cancer: results of an 11-year cohort study. Int J Gynecol Cancer 2006; 16 Suppl 1:54-9. [PMID: 16515568 DOI: 10.1111/j.1525-1438.2006.00480.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The outcome of screening and prophylactic surgery in 269 women at high risk of hereditary ovarian cancer is reported. Screening was performed using transvaginal ultrasound and serum CA125 testing. Mean follow-up was 26 months (583 person-years). A total of 113 (42%) of 269 women had a pathogenic BRCA1 or BRCA2 mutation, and 127 (47%) of 269 women underwent salpingo-oophorectomy. No occult cancers were found. In eight women having both elevated CA125 levels and abnormal ultrasound findings, a malignancy was found. Four of these cancers (one borderline, one stage Ia, one stage IIIb, and one stage IIIc ovarian or peritoneal cancer) were detected at the first screening visit. One stage IIIb and one stage IIIc cancer were detected at the second screening visit after 12 months, and two interval stage IIIc and IV cancers were detected 8 and 10 months after the first screening visit. No peritoneal carcinoma was found among those 114 women who underwent bilateral salpingo-oophorectomy with normal or benign pathology results, after a mean follow-up of 16 months (152 person-years). We conclude that the efficacy of screening women at high risk of ovarian cancer seems poor because the majority of cancers were detected at an advanced stage.
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Affiliation(s)
- K N Gaarenstroom
- Department of Gynecology, , Leiden University Medical Center, Leiden, The Netherlands
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de Kroon CD, van Dongen H, Jansen FW. [Gynaecological diagnosis of postmenopausal women with abnormal vaginal bleeding: a comparison with the guideline]. Ned Tijdschr Geneeskd 2006; 150:586; author reply 586-7. [PMID: 16566430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Kolkman W, Wolterbeek R, Jansen FW. Implementation of advanced laparoscopy into daily gynecologic practice: Difficulties and solutions. J Minim Invasive Gynecol 2006; 13:4-9. [PMID: 16431316 DOI: 10.1016/j.jmig.2005.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 08/01/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- W Kolkman
- Leiden University Medical Center, Department of Gynecology, K6-76, Leiden, The Netherlands
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Kolkman W, Wolterbeek R, Jansen FW. Gynecological laparoscopy in residency training program: Dutch perspectives. Surg Endosc 2005; 19:1498-502. [PMID: 16206008 DOI: 10.1007/s00464-005-0291-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 05/08/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Implementation of laparoscopy into residency training is difficult. This study was conducted to assess the current state of implementation of laparoscopic surgery into gynecological residency program, to identify factors influencing laparoscopic skills training, and to find solutions toward better training and implementation. METHODS In 2003 a questionnaire was sent to all 68 postgraduate year 5 and year 6 residents in obstetrics and gynecology in The Netherlands. The questionnaire addressed demographics, performance of laparoscopy, self-perceived competence, simulator training, and factors influencing laparoscopic training in residency. RESULTS Of the 68 residents, 60 (88%) responded; 46 (37%) were men and 78 (63%) women. Men showed significant higher mean self-perceived competence in some laparoscopic procedures than women. Of the respondents, 20% had no advanced laparoscopic gynecologist present in their teaching hospital. Residents felt that simulator training is important in relation to their performance in the operating room. Of all gynecological teaching hospitals in the Netherlands, 55% did not have the opportunity of simulator training. Of the respondents who had the possibility of simulator training, 33% did not use the simulator voluntarily. Residents who trained on a simulator felt training was significantly more important (p = 0.02) than residents who never practiced on a simulator. Respondents' laparoscopic skills were subjectively evaluated in the operating room (92%) or were evaluated based on the number of laparoscopic procedures performed as primary surgeon (49%). Of the respondents, 47% were satisfied with their current laparoscopic skills and 27% also felt prepared for the more advanced procedures. Not having been primary surgeon in nonacademic teaching hospitals and even more so in academic teaching hospitals (p < 0.05) was a limiting factor in acquiring laparoscopic skills. CONCLUSIONS Incorporation of basic laparoscopic procedures into residency training has been successful; however, advanced procedures are not. Simulator training is still in its infancy in The Netherlands, is not frequently used voluntarily, and should be mandatory during residency. Acquired laparoscopic skills on a simulator and in the operating room should be objectively assessed, and above all, training of trainers is imperative.
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Affiliation(s)
- W Kolkman
- Department of Gynecology, K6-76, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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de Kroon CD, van der Sandt HAGM, van Houwelingen JC, Jansen FW. Sonographic assessment of non-malignant ovarian cysts: does sonohistology exist? Hum Reprod 2004; 19:2138-43. [PMID: 15192068 DOI: 10.1093/humrep/deh353] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transvaginal ultrasound (TVU) is feasible and accurate in the differentiation between non-malignant and malignant ovarian abnormalities. However, despite the clinical relevance, the accuracy of TVU in the differentiation between the many different non-malignant cysts is unknown. METHODS Between 1992 and 2002, all women who had surgery at our centre because of a non-malignant ovarian cyst were included prospectively in this study. The sonographic characteristics as well as the expected histological diagnosis (the 'sonohistological diagnosis') were evaluated pre-operatively. This diagnosis was compared with the histopathological diagnosis, and diagnostic parameters [with 95% confidence interval (CI)] of the sonohistological diagnosis were calculated. Logistic models, with the sonographic characteristics as variables, were constructed for each histopathological diagnosis. RESULTS A total of 406 women were included consecutively. The overall diagnostic accuracy of the sonohistological diagnosis was 60% (95% CI 0.56-0.65). Only in cases of simple ovarian cysts did the diagnostic accuracy of the respective logistic model exceed that of the sonohistological diagnosis (0.88 versus 0.81, P < 0.01). The diagnostic accuracy of the sonohistological diagnosis for endometriotic and dermoid ovarian cysts was significantly better compared with the respective logistic model (0.84 versus 0.71, P < 0.01 and 0.87 versus 0.82, P = 0.03, respectively). CONCLUSION In approximately half of the non-malignant ovarian cysts, TVU is capable of distinguishing between the different histopathological diagnoses of non-malignant ovarian masses. Only in the diagnosis of simple ovarian cysts might use of the logistic models be helpful.
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Affiliation(s)
- C D de Kroon
- Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Dunker MS, Bemelman WA, Vijn A, Jansen FW, Peters AAW, Janss RAJ, Gouma DJ. Long-term outcomes and quality of life after laparoscopic adhesiolysis for chronic abdominal pain. ACTA ACUST UNITED AC 2004; 11:36-41. [PMID: 15104828 DOI: 10.1016/s1074-3804(05)60007-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To evaluate clinical outcome in terms of pain and quality of life after laparoscopic adhesiolysis. DESIGN Prospective observational study (Canadian Task Force II-3). SETTING University-affiliated medical center. PATIENTS Twenty-three patients (22 women). INTERVENTION Laparoscopic adhesiolysis for chronic abdominal pain. MEASUREMENTS AND MAIN RESULTS Pain was assessed by validated McGill score. Patients with an intraindividual decrease in pain score of 5 points or more were considered successes. Quality of life was assessed by the SF-36 and gastrointestinal quality of life index. Patients were evaluated before and at intervals until 2 years after adhesiolysis. The mean pain score before adhesiolysis was 30.5 (range: 17-40). At 2 years of follow-up, 10 (45%) of 22 patients (95% CI 0.244-0.678) were considered successes. They reported significant improvement in quality of life on scales physical, role physical, and social function, and fewer gastrointestinal symptoms. Twelve women (55%) had a complete relapse, and most were not motivated to visit the pain clinic after 6 months. CONCLUSION Laparoscopic adhesiolysis for chronic abdominal pain was successful in only 45% of patients.
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Affiliation(s)
- M S Dunker
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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de Kroon CD, van Houwelingen JC, Trimbos JB, Jansen FW. The value of transvaginal ultrasound to monitor the position of an intrauterine device after insertion. A technology assessment study. Hum Reprod 2003; 18:2323-7. [PMID: 14585882 DOI: 10.1093/humrep/deg433] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The intrauterine device (IUD) is an effective contraceptive method. The contraceptive power as well as the side-effects of IUD are thought to relate to the position of the IUD in the uterine cavity. We assessed the accuracy of clinical evaluation of IUD position. METHODS A prospective comparative study was performed. The clinical evaluation was compared with the TVU measurement of IUD position both immediately after insertion and 6 weeks after insertion. The primary outcome measures were the positive and negative predictive values (PPV and NPV) of the clinical evaluation of IUD position. RESULTS 195 women were included consecutively, 181 women (92.8%) were available for follow-up. The PPV and NPV of clinical evaluation of IUD position immediately after insertion were respectively 0.60 (95% CI: 0.39-0.81) and 0.98 (95% CI: 0.96-1.0). The prevalence of an abnormally positioned IUD was 7.7% (95% CI: 3.9-11.4). The PPV and NPV of the clinical evaluation at follow-up were respectively 0.54 (95% CI: 0.26-0.81) and 1.0 (95% CI: 0.98-1.0). The prevalence of abnormal position was 4.0% (95% CI: 1.7-7.1). CONCLUSION Clinical evaluation is an excellent test for the evaluation of the position of an IUD and routine TVU is not indicated for this purpose.
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Affiliation(s)
- C D de Kroon
- Department of Gynaecology, Leiden University Medical Center, P.O.Box 9600, 2300 RC Leiden, The Netherlands
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de Kroon CD, Jansen FW, Trimbos JB. [Efficiency of saline contrast hysterosonography for evaluating the uterine cavity]. Ned Tijdschr Geneeskd 2003; 147:1539-44. [PMID: 12942842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Diagnostic hysteroscopy is the standard investigation performed in the case of abnormal vaginal blood loss. More recently there has been increasing interest for minimal invasive saline contrast hysterosonography (SCHS) as this technique is less painful and less expensive. SCHS is indicated in case of abnormal uterine bleeding (premenopausal and postmenopausal), bleeding while using tamoxifen, suspicion of a congenital uterine abnormality and Asherman's syndrome. As well as intracavity abnormalities (polyps and myomas) SCHS can also be used to evaluate the intramural extension of myomas, which is necessary to assess whether hysteroscopic resection is possible. The sensitivity and specificity of SCHS for demonstrating intracavity abnormalities (with a prevalence of 54%) are 94% (95%-CI; 91-97) and 89% (95%-CI: 85-94) respectively. The positive and negative predictive values are 91% (95%-CI: 87-95) and 92% (95%-CI: 89-97) respectively. SCHS has a short learning curve and can be performed in an outpatient setting. SCHS fails more frequently in postmenopausal women than premenopausal women (12.5% vs. 4.7%; p = 0.03). The chance of a non-conclusive SCHS is 7.6% and is higher if the uterine volume is greater than 600 cm3 (relative risk: 2.63; 95%-CI: 1.05-6.60) and if two or more myomas are present: (RR 2.65; 95%-CI: 1.16-6.10). SCHS is 2 to 9 times cheaper than diagnostic hysteroscopy. It can replace 84% of the diagnostic hysteroscopies. SCHS, in combination with endometrial sampling, whenever indicated, might be able to replace diagnostic hysteroscopy as gold standard in the evaluation of the uterine cavity.
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Affiliation(s)
- C D de Kroon
- Leids Universitair Medisch Centrum, afd. Gynaecologie, Postbus 9600, 2300 RC Leiden.
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Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi C, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 2002; 16:1121-43. [PMID: 12015619 DOI: 10.1007/s00464-001-9166-7] [Citation(s) in RCA: 360] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2001] [Accepted: 09/26/2001] [Indexed: 12/26/2022]
Abstract
BACKGROUND The pneumoperitoneum is the crucial element in laparoscopic surgery. Different clinical problems are associated with this procedure, which has led to various modifications of the technique. The aim of this guideline is to define the scientifically proven standards of the pneumoperitoneum. METHODS Based on systematic literature searches (Medline, Embase, and Cochrane), an expert panel consensually formulated clinical recommendations, which were graded according to the strength of available literature evidence. RECOMMENDATIONS Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.
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Affiliation(s)
- J Neudecker
- Department of Surgery, Charité Campus Mitte, Humboldt-University of Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany
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de Waard J, Weijenborg PTM, ter Kuile MM, Jansen FW. [Request for labia correction: sometimes more than a simple question]. Ned Tijdschr Geneeskd 2002; 146:1209-12. [PMID: 12132133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Three women aged 19, 50 and 33 years, requested surgical correction of their labia minora because of subjective complaints attributed to the size of their labia minora. However, during consultation, for one of the patients it transpired that she did not know anything about the normal physiological changes of the external genitals during puberty and the enormous variety and diversity of the length of labia minora between women. It turned out that the other woman felt uncertain about her genitals following a recent divorce. For the third woman a vulvar pain syndrome and a sexual abuse history became clear. Two of the patients decided not to undergo surgery and the third sought a cure elsewhere. The request for a surgical correction of the labia minora seems quite simple and the operation does not seem to be complicated either. However, the question remains as to whether an operation is the solution for the psychological and behavioural consequences the woman experiences. A conservative approach is recommended, with attention for other possible problems that can be hidden behind the request for labia minora correction.
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Affiliation(s)
- J de Waard
- Leids Universitair Medisch Centrum, Polikliniek Gynaecologie, Postbus 9600, 2300 RC Leiden
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