Operative laparoscopy in The Netherlands: Diffusion and acceptance

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Abstract

Objective

To evaluate and update the current status of the implementation of operative laparoscopy in gynaecology in The Netherlands by assessing diffusion and acceptance of each specific procedure per hospital.

Study design

In 2003 a questionnaire was sent to all hospitals (n = 102), which addressed the total number and type of laparoscopic procedures performed in 2002 stratified by level of difficulty (level 1: diagnostic laparoscopy, sterilization, tubal patency tests; level 2: adhesiolysis, ectopic pregnancy (EP), laparoscopic treatment of endometriosis, cystectomy, oophorectomy, LAVH, tubal surgery for infertility; level 3: myomectomy, total laparoscopic hysterectomy (TLH) and sacropexy). Data were compared to previously published data of 1994.

Results

Response rate was 79% (81/102). Diffusion and acceptance of level 2 procedures increased significantly, except endometriosis and tubal surgery for infertility. Diffusion of LAVH was only 58%. Four percent of hysterectomies were LAVH. TLH and sacropexy were not performed. The diffusion of myomectomy increased significantly (p = 0.01), whereas its acceptance remained low.

Conclusions

Although the diffusion of operative procedures has increased over the last decade, acceptance is still limited, especially for laparoscopic hysterectomy. The implementation of operative gynaecological laparoscopy in The Netherlands seems to develop at a slow pace.

Introduction

Initially, gynaecological laparoscopy was performed for diagnostic purposes and sterilization, later also for operative procedures. Nowadays, laparoscopy has developed into an important component of the operative gynaecological palette, since it is accepted as an alternative to conventional gynaecological surgery for many indications. However, the introduction of this new surgical technique has shown to bring along difficulties incorporating into daily practice, especially advanced operative procedures. Therefore it is important to assess the degree of diffusion and acceptance [1], [2], [3], [4] and use this information to guide further implementation at regional and (inter)national levels.

Implementation of laparoscopy is objectified in two ways. First, the diffusion of every specific procedure can be examined, defined by the percentage of hospitals where the different types of laparoscopic procedures are performed. And second, the extent of acceptance of each specific procedure per hospital can be examined, defined by the number of different laparoscopic procedures performed per hospital. Considering the diffusion and acceptance of every type of laparoscopic procedure, conclusions can be made on the implementation of gynaecological laparoscopy [5].

The objective of this study was to elucidate the implementation of laparoscopy in operative gynaecology in The Netherlands as a follow up of previous studies [6], [7].

Section snippets

Materials and methods

In 2003 a questionnaire was sent to all hospitals (n = 102) in The Netherlands. The questionnaire addressed the total number and type of all gynaecological laparoscopic procedures (LS) that were performed in each hospital in 2002. Also the numbers of abdominal and vaginal hysterectomies (oncology excluded), as well as the numbers of conventional procedures per laparotomy for cystectomy, oophorectomy and ectopic pregnancy (EP) were collected.

For this questionnaire each envelope contained a letter

Results

Of all 102 hospitals, 81 (79%) returned the questionnaire. Not all questionnaires were returned with all items completed. Therefore the denominators in the analyses did not always add up to the total number of questionnaires returned.

In 2002 the majority of cystectomies (69%) and EP's (71%) were performed laparoscopically, whereas the minority of oophorectomies (40%) was performed by laparoscopy (oncology excluded), as shown in Table 1.

The different approaches to hysterectomy are detailed in

Discussion

Although the diffusion of these procedures has increased over the last decade, the acceptance is still limited, especially for LAVH and the more advanced laparoscopic procedures (level 3). The implementation of operative gynaecological laparoscopy in The Netherlands seems to develop at a slow pace.

In 1998, 12% of all ovarian surgery (cystectomy and oophorectomy) and 28% of all surgery for EP's was performed laparoscopically in The Netherlands [9]. In 2002 these numbers have rapidly expanded to

Acknowledgement

We thank all gynaecologists who completed the questionnaire for their cooperation.

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