The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study

Raanan Meyer; Rebecca J Schneyer; Kacey M Hamilton; Gabriel Levin; Mireille D Truong; Matthew T Siedhoff; Kelly N Wright

doi:10.1016/j.jmig.2024.09.012

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study

J Minim Invasive Gynecol. 2024 Sep 19:S1553-4650(24)00417-5. doi: 10.1016/j.jmig.2024.09.012. Online ahead of print.

Authors

Raanan Meyer¹, Rebecca J Schneyer², Kacey M Hamilton², Gabriel Levin³, Mireille D Truong², Matthew T Siedhoff², Kelly N Wright²

Affiliations

¹ Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Drs. Meyer, Schneyer, Hamilton, Truong, Siedhoff, and Wright); The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel (Dr. Meyer). Electronic address: raanan.meyer@cshs.org.
² Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Drs. Meyer, Schneyer, Hamilton, Truong, Siedhoff, and Wright).
³ Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada (Dr. Levin).

PMID: 39305984
DOI: 10.1016/j.jmig.2024.09.012

Abstract

Study objective: To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GOs), or general obstetrician/gynecologists (OB/GYNs).

Design: Retrospective cohort study.

Setting: Quaternary care academic hospital.

Patients: Patients undergoing MIH for benign indications from March 2015 to March 2020 were included.

Interventions: MIH.

Measurements and main results: The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons' group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.36-3.71), and 25.9% of the OB/GYN group (OR, 2.65; 95% CI, 1.70-4.12). Major intra- or postoperative complications were associated with surgeons' groups (OR, 7.02; 95% CI, 2.67-18.47, and OR, 6.84; 95% CI, 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%; OR, 7.21; 95% CI, 2.52-20.60) and OB/GYNs (9.7%; OR, 7.82; 95% CI, 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs than MIGS (18.5% vs 10.9%; OR, 1.86; 95% CI, 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared with GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs than MIGS surgeons (OR, 2.12; 95% CI, 1.07-4.22; OR, 2.48; 95% CI, 1.49-4.12, respectively).

Conclusion: Fellowship-trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.

Keywords: Complications; Fellowship training; Gynecologic oncology; Robotic surgery.