Cargando…

How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

INTRODUCTION: Hysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of...

Descripción completa

Detalles Bibliográficos
Autores principales: Obermair, Andreas, Armfield, Nigel R, Graves, Nicholas, Gebski, Val, Hanna, George B, Coleman, Mark G, Hughes, Anne, Janda, Monika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528001/
https://www.ncbi.nlm.nih.gov/pubmed/31072858
http://dx.doi.org/10.1136/bmjopen-2018-027155
_version_ 1783420130157395968
author Obermair, Andreas
Armfield, Nigel R
Graves, Nicholas
Gebski, Val
Hanna, George B
Coleman, Mark G
Hughes, Anne
Janda, Monika
author_facet Obermair, Andreas
Armfield, Nigel R
Graves, Nicholas
Gebski, Val
Hanna, George B
Coleman, Mark G
Hughes, Anne
Janda, Monika
author_sort Obermair, Andreas
collection PubMed
description INTRODUCTION: Hysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH). METHODS AND ANALYSIS: Stepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals. PRIMARY OUTCOMES: Change in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention; we aim to reduce TAH by at least 30% in 75% of the trainees. SECONDARY OUTCOMES: (1) Number of hospitals screened, eligible, agree to training and complete the training; (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency; (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure; change in proportion proficient over time; (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay >7 days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection); (5) hospital length-of-stay; (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH. ETHICS AND DISSEMINATION: The study has been approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03617354; Pre-results.
format Online
Article
Text
id pubmed-6528001
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-65280012019-06-05 How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial Obermair, Andreas Armfield, Nigel R Graves, Nicholas Gebski, Val Hanna, George B Coleman, Mark G Hughes, Anne Janda, Monika BMJ Open Obstetrics and Gynaecology INTRODUCTION: Hysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH). METHODS AND ANALYSIS: Stepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals. PRIMARY OUTCOMES: Change in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention; we aim to reduce TAH by at least 30% in 75% of the trainees. SECONDARY OUTCOMES: (1) Number of hospitals screened, eligible, agree to training and complete the training; (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency; (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure; change in proportion proficient over time; (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay >7 days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection); (5) hospital length-of-stay; (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH. ETHICS AND DISSEMINATION: The study has been approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03617354; Pre-results. BMJ Publishing Group 2019-05-09 /pmc/articles/PMC6528001/ /pubmed/31072858 http://dx.doi.org/10.1136/bmjopen-2018-027155 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Obstetrics and Gynaecology
Obermair, Andreas
Armfield, Nigel R
Graves, Nicholas
Gebski, Val
Hanna, George B
Coleman, Mark G
Hughes, Anne
Janda, Monika
How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial
title How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial
title_full How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial
title_fullStr How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial
title_full_unstemmed How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial
title_short How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial
title_sort how to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge imagine trial
topic Obstetrics and Gynaecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528001/
https://www.ncbi.nlm.nih.gov/pubmed/31072858
http://dx.doi.org/10.1136/bmjopen-2018-027155
work_keys_str_mv AT obermairandreas howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT armfieldnigelr howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT gravesnicholas howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT gebskival howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT hannageorgeb howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT colemanmarkg howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT hughesanne howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial
AT jandamonika howtotrainpractisinggynaecologistsintotallaparoscopichysterectomyprotocolforthesteppedwedgeimaginetrial