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The impact of systematic laparoscopic skills and suture training on laparoscopic hysterectomy outcomes in a brazilian teaching hospital / O impacto do treinamento laparoscópico sistematizado de habilidades e sutura nos resultados da histerectomia laparoscópica em hospital universitário brasileiro
Department of Obstetrics and GynecologyGonçalves, Anna Luiza Lobão; Department of Obstetrics and GynecologyAyroza-Ribeiro, Helizabet Abdala; Department of Obstetrics and GynecologyLima, Raquel Ferreira; Department of Obstetrics and GynecologyYonamine, Aline Estefane Eras; Department of Obstetrics and GynecologyOhara, Fabio; Department of Obstetrics and GynecologyAyroza-Ribeiro, Paulo Augusto Galvão.
  • Department of Obstetrics and GynecologyGonçalves, Anna Luiza Lobão; Santa Casa de São Paulo. Faculdade de Ciências Médicas. Department of Obstetrics and GynecologyGonçalves, Anna Luiza Lobão. São Paulo. BR
  • Department of Obstetrics and GynecologyAyroza-Ribeiro, Helizabet Abdala; Santa Casa de São Paulo. Faculdade de Ciências Médicas. Department of Obstetrics and GynecologyAyroza-Ribeiro, Helizabet Abdala. São Paulo. BR
  • Department of Obstetrics and GynecologyLima, Raquel Ferreira; Santa Casa de São Paulo. Faculdade de Ciências Médicas. Department of Obstetrics and GynecologyLima, Raquel Ferreira. São Paulo. BR
  • Department of Obstetrics and GynecologyYonamine, Aline Estefane Eras; Santa Casa de São Paulo. Faculdade de Ciências Médicas. Department of Obstetrics and GynecologyYonamine, Aline Estefane Eras. São Paulo. BR
  • Department of Obstetrics and GynecologyOhara, Fabio; Santa Casa de São Paulo. Faculdade de Ciências Médicas. Department of Obstetrics and GynecologyOhara, Fabio. São Paulo. BR
  • Department of Obstetrics and GynecologyAyroza-Ribeiro, Paulo Augusto Galvão; Santa Casa de São Paulo. Faculdade de Ciências Médicas. Department of Obstetrics and GynecologyAyroza-Ribeiro, Paulo Augusto Galvão. São Paulo. BR
Rev. bras. ginecol. obstet ; 41(12): 718-725, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057886
ABSTRACT
Abstract Objective To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital. Methods A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program. Results A total of 244 TLH patients (mean age 45.93 years) were included 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p=0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p=0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p=0.030), logistic regression did not find any association between uterine volume and surgical time (p=0.103). Conclusion The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.
RESUMO
Resumo Objetivo Avaliar o impacto do treinamento laparoscópico sistematizado de habilidades e sutura (TLSHS) nos resultados intra e pós-operatórios da histerectomia laparoscópica em um hospital universitário brasileiro. Métodos Estudo observacional transversal de revisão de 244 prontuários de pacientes submetidas a histerectomia total laparoscópica (HTL) operadas entre 2008 e 2014. Os fatores específicos das pacientes (idade, paridade, cesariana prévia, cirurgias abdominais, e endometriose) e as variáveis relacionadas à cirurgia (tempo de hospitalização, tempo de cirurgia, volume uterino e complicações operatórias) foram analisados em três grupos temporais 2008-09 (I-1) - HTLs realizadas por médicos experientes; 2010-11 (I-2) - HTLs realizadas por residentes sem TLSHS; 2012-2014 (I-3) - HTLs realizadas por residentes após a implementação do TLSHS. Resultados Um total de 244 pacientes submetidas a HTLs foram incluídas (média de idade de 45,93 anos) 24 operadas no período I1, 55 no I2, e 165 no I3. A principal indicação para HTL foi mioma uterino (66,4%). O grupo I-3 apresentou diminuição no tempo cirúrgico quando comparado ao grupo I-2 (p=0,010). Hospitalização superior a 2 dias diminuiu no grupo I-3 comparado ao grupo I-2 (p=0,010). Apesar de observarmos diminuição no volume uterino dos pacientes do grupo I-2 (154,2 cm3) em comparação com os do grupo I-1 (217,8 cm3) (p=0,030), a regressão logística não revelou associação entre volume uterino e tempo cirúrgico (p=0,103). Conclusão O tempo cirúrgico na HTL foi significativamente menor no grupo de pacientes submetidas à cirurgia após a implantação do TLSHS em nosso hospital.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Suture Techniques / Clinical Competence / Laparoscopy / Hysterectomy Type of study: Observational study / Prevalence study / Risk factors Limits: Adult / Female / Humans Country/Region as subject: South America / Brazil Language: English Journal: Rev. bras. ginecol. obstet Journal subject: Gynecology / Obstetrics Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Santa Casa de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Suture Techniques / Clinical Competence / Laparoscopy / Hysterectomy Type of study: Observational study / Prevalence study / Risk factors Limits: Adult / Female / Humans Country/Region as subject: South America / Brazil Language: English Journal: Rev. bras. ginecol. obstet Journal subject: Gynecology / Obstetrics Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Santa Casa de São Paulo/BR