Journal Mobile Options
Table of Contents
Vol. 64, No. 1, 2007
Issue release date: July 2007
Gynecol Obstet Invest 2007;64:1–7
(DOI:10.1159/000098315)

Teach the Teachers: An Observational Study on Mentor Traineeship in Gynecological Laparoscopic Surgery

Kolkman W. · Engels L.E. · Smeets M.J.G.H. · Jansen F.W.
aDepartment of Gynecology, Leiden University Medical Center, Leiden, and bDepartment of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: To evaluate the effect of a mentor traineeship in laparoscopic surgery in a teaching hospital. Method: This observational study was performed between January 1997 and December 2004 at Bronovo Hospital, The Hague, The Netherlands. Since January 2001, an advanced endoscopic gynecologist has mentored a trainee in laparoscopic surgery. Data on the trainee’s procedures preceding (1997–2000) and during the mentor traineeship (2001–2004) were compared. The number and type of procedures performed, complications and conversions were derived from a prospectively kept database supplemented by a retrospective chart review. Operating times for total laparoscopic hysterectomy (TLH) were registered to establish the trainee’s learning curve. Results: Since the presence of a mentor, the trainee has performed significantly more advanced laparoscopic procedures. Despite the significant increase in advanced cases, the trainee’s laparoscopic conversion rate to laparotomy remained stable between period 1 and period 2 (7.5 and 4.5%, respectively, p = 0.35, 95% CI –0.033 to 0.092); moreover, for level-3 procedures the conversion rate decreased (p < 0.001, 95% CI 0.30–0.71). Despite the increase in advanced cases, the total complication rate remained stable (3.2–4.5%, p = 0.62, 95% CI –0.07 to 0.04) including the number of level-3 complications (p = 0.63, 95% CI –0.4 to 0.3). A decreasing trend in operating time for TLH was found; however, this was not significant (Spearman correlation coefficient –0.421, p = 0.81). Conclusions: Mentor traineeship in gynecology enhanced the advanced laparoscopic caseload. With the increase in advanced procedures, no increase in conversion rate, complication rate or operating times for TLH was found. Due to the mentorship, patients were not exposed to increased complications and conversions, or to the disadvantages of a prolonged operating time. Predominantly, mentor traineeship facilitated the implementation of laparoscopic surgery into an established gynecological practice in a teaching hospital.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Integrating advanced laparoscopy into surgical residency training: Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Surg Endosc 1998;12:374–376.
  2. Navez B, Penninckx F: Laparoscopic training: results of a Belgian survey in trainees. Belgian Group for Endoscopic Surgery (BGES). Acta Chir Belg 1999;99:53–58.
  3. Loh FH, Hameed N, Ng SC: The impact of minimal access surgery on gynecological surgery in a university gynecological unit over a 10-year period from 1991 to 2000. Singapore Med J 2002;43:177–181.
  4. Nussbaum MS: Surgical endoscopy training is integral to general surgery residency and should be integrated into residency and fellowships abandoned. Semin Laparosc Surg 2002;9:212–215.
  5. Kolkman W, Wolterbeek R, Jansen FW: Gynecological laparoscopy in residency training program: Dutch perspectives. Surg Endosc 2005;19:1498–1502.
  6. Fowler DL, Hogle N: The impact of a full-time director of minimally invasive surgery: clinical practice, education, and research. Surg Endosc 2000;14:444–447.
  7. Schijven MP, Berlage JT, Jakimowicz JJ: Minimal-access surgery training in the Netherlands: a survey among residents-in-training for general surgery. Surg Endosc 2004;18:1805–1814.
  8. Gallagher AG, McClure N, McGuigan J, Ritchie K, Sheehy NP: An ergonomic analysis of the fulcrum effect in the acquisition of endoscopic skills. Endoscopy 1998;30:617–620.
  9. Rogers DA, Elstein AS, Bordage G: Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery. Ann Surg 2001;233:159–166.
  10. Feldman LS, Sherman V, Fried GM: Using simulators to assess laparoscopic competence: ready for widespread use? Surgery 2004;135:28–42.
  11. Fabrizio MD, Tüerk I, Schellhammer PF: Laparoscopic radical prostatectomy: Decreasing the learning curve using a mentor initiated approach. J Urol 2003;169:2063–2065.
  12. Royal College of Obstetricians and Gynaecologists (RCOG): Classification of Laparoscopic Procedures per Level of Difficulty. London, RCOG, 2001.
  13. Brolmann HA, Vervest HA, Heineman MJ: Declining trend in major gynecological surgery in the Netherlands during 1991–1998. Is there an impact on surgical skills and innovative ability? BJOG 2001;108:743–748.
  14. 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.
  15. Kolkman W, Trimbos-Kemper TC, Jansen FW: Operative laparoscopy in the Netherlands: diffusion and acceptance. Eur J Obstet Gynecol Reprod Biol 2006;Epub ahead of print.
  16. Royal College of Obstetricians and Gynecologists (RCOG): Medical Workforce Census: Overall statistics for England and Wales. London, RCOG, 2004.
  17. Rosser JC Jr, Murayama M, Gabriel NH: Minimally invasive surgical training solutions for the twenty-first century. Surg Clin North Am 2000;80:1607–1624.
  18. Jansen FW, Kapiteyn K, Trimbos-Kemper T, Hermans J, Trimbos JB: Complications of laparoscopy: a prospective multicentre observational study. Br J Obstet Gynaecol 1997;104:595–600.
  19. Chapron C, Querleu D, Bruhat MA, Madelenat P, Fernandez H, Pierre F, Dubuisson JB: Surgical complications of diagnostic and operative gynecological laparoscopy: a series of 29,966 cases. Hum Reprod 1998;13:867–872.
  20. Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S: Predicting risk of complications with gynecologic laparoscopic surgery. Obstet Gynecol 1998;92:327–331.
  21. Harkki-Siren P, Sjoberg J, Kurki T: Major complications of laparoscopy: a follow-up Finnish study. Obstet Gynecol 1999;94:94–98.
  22. Jansen FW, Vredevoogd CB, van Ulzen K, Hermans J, Trimbos JB, Trimbos-Kemper TC: Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 2000;96:266–270.
  23. Leonard F, Lecuru F, Rizk E, Chasset S, Robin F, Taurelle R: Perioperative morbidity of gynecological laparoscopy. A prospective monocenter observational study. Acta Obstet Gynecol Scand 2000;79:129–134.
  24. Sokol AI, Chaung K, Milad MP: Risk factors for conversion to laparotomy during gynecologic laparoscopy. J Am Assoc Gynecol Laparosc 2003;10:469–473.
  25. Shay BF, Thomas R, Monga M: Urology practice patterns after residency training in laparoscopy. J Endourol 2002;16:251–256.
  26. Altgassen C, Michels W, Schneider A: Learning laparoscopic-assisted hysterectomy. Obstet Gynecol 2004;104:308–313.
  27. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M: Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84:273–278.
  28. Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondre K, Stanbridge D, Fried GM: A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 2005;190:107–113.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50