Fertility and sterility · 2013
Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands.
Клиническое исследованиеСтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Janse Juliënne A, Pattij Thyrza O S, Eijkemans Marinus J C, Broekmans Frank J, Veersema Sebastiaan, Schreuder Henk W R
Аннотация
OBJECTIVE: To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands.
DESIGN: Prospective multicenter study (Canadian Task Force II-2).
SETTING: Ten community (teaching) hospitals in the Netherlands.
PATIENT(S): A total of 631 women who underwent permanent sterilization by tubal microinserts.
INTERVENTION(S): Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement.
MAIN OUTCOME MEASURE(S): Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications.
RESULT(S): Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience.
CONCLUSION(S): A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience.
DESIGN: Prospective multicenter study (Canadian Task Force II-2).
SETTING: Ten community (teaching) hospitals in the Netherlands.
PATIENT(S): A total of 631 women who underwent permanent sterilization by tubal microinserts.
INTERVENTION(S): Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement.
MAIN OUTCOME MEASURE(S): Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications.
RESULT(S): Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience.
CONCLUSION(S): A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience.