Rebecca J Schneyer, Raanan Meyer, Margot L Barker, Kacey M Hamilton, Matthew T Siedhoff, Mireille D Truong, Kelly N Wright
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引用次数: 0
Abstract
Study objective: To compare surgical outcomes among patients undergoing minimally invasive myomectomy (MIM) or abdominal myomectomy (AM) with MIGS subspecialists versus general obstetrician/gynecologists (OB/GYNs), and to characterize the complexity of myomectomies by surgeon type.
Design: Retrospective cohort study.
Setting: Quaternary care institution.
Participants: Patients who underwent MIM (laparoscopic or robotic) or AM with a fellowship-trained MIGS subspecialist or general OB/GYN from March 15, 2015 to March 14, 2020.
Interventions: Myomectomy.
Results: Of 609 myomectomies, 460 (75.5%) were MIM, 404 (87.8%) of which were performed by MIGS subspecialists. The remaining 149 (24.5%) cases were AM, 36 (24.1%) of which were performed by MIGS subspecialists. Compared to general OB/GYNs, MIGS subspecialists excised a greater number of fibroids for both MIM (median 3.0 [range 1.0-30.0] vs 2.0 [1.0-9.0], p <.001) and AM (21.0 [10.0-60.0] vs 6.0 [1.0-42.0], p <.001), and had a greater proportion of uteri >20 weeks size for AM (22.2% vs 3.5%, p = .003). Composite perioperative complication rates were significantly higher for general OB/GYNs than for MIGS subspecialists (29.0% vs 11.8%, adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 1.48-4.92). In a subgroup analysis of MIM only, general OB/GYNs had higher rates of composite perioperative complications (28.6% vs 9.9%, aOR 4.51, 95% CI 2.27-8.97), excessive blood loss and/or transfusion (10.7% vs 3.0%, unadjusted odds ratio [OR] 3.92, 95% CI 1.41-10.91), surgery time ≥ 90th percentile (25.0% vs 8.9%, aOR 5.05, 95% CI 2.39-10.64), and conversions to laparotomy (10.7% vs 0.2%, unadjusted OR 48.36, 95% CI 5.71-409.93). For AM only, there were no significant differences in perioperative complication rates between groups.
Conclusion: Fellowship-trained MIGS subspecialists had improved surgical outcomes for MIM compared to general OB/GYNs, with fewer conversions to laparotomy, reduced surgery time, and less blood loss, while outcomes for AM were similar by surgeon type. MIGS subspecialists excised a greater number of fibroids regardless of surgical approach, highlighting a level of comfort in complex benign gynecology beyond endoscopic surgery at our institution.
研究目的：比较微创子宫肌瘤切除术（MIM）或腹部子宫肌瘤切除术（AM）患者与MIGS亚专科医生和普通妇产科医生（OB/GYNs）的手术效果，并按外科医生类型描述子宫肌瘤切除术的复杂性。设计：回顾性队列研究。环境：四级护理机构。参与者：2015年3月15日至2020年3月14日期间接受MIM（腹腔镜或机器人）或AM（由奖学金培训的MIGS专科医生或普通妇产科医生）的患者。干预措施:肌瘤切除术。结果：609例子宫肌瘤切除术中，460例（75.5%）为MIM， 404例（87.8%）为mis亚专科。其余149例（24.5%）为AM，其中36例（24.1%）由MIGS专科医生执行。与普通妇产科医生相比，MIM（中位数3.0[范围1.0-30.0]）和AM（中位数2.0[1.0-9.0]）的子宫肌瘤切除数量都更多（中位数3.0[范围1.0-30.0]），AM的子宫肌瘤大小为p20周（22.2%对3.5%,p= 0.003）。综合围手术期并发症发生率，普通妇产科医生明显高于MIGS专科医生（29.0% vs 11.8%，调整优势比[aOR] 2.70, 95%可信区间[CI] 1.48-4.92）。在仅MIM的亚组分析中，普通OB/ gyn的围手术期复合并发症发生率更高（28.6%比9.9%,aOR 4.51, 95% CI 2.27-8.97），过多失血和/或输血（10.7%比3.0%，未经调整的优势比[or] 3.92, 95% CI 1.41-10.91），手术时间≥90%(25.0%比8.9%,aOR 5.05, 95% CI 2.39-10.64)，转行剖腹手术（10.7%比0.2%，未经调整的or 48.36, 95% CI 5.71-409.93）。仅AM组围手术期并发症发生率组间差异无统计学意义。结论：与普通妇产科医生相比，接受过研究金培训的MIGS专科医生的MIM手术效果更好，转开腹手术次数更少，手术时间更短，出血量更少，而AM的手术效果与外科医生类型相似。无论采用何种手术方式，MIGS专科医生都切除了更多的肌瘤，突出了我们机构在内窥镜手术之外的复杂良性妇科手术的舒适度。
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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