Trends in the Implementation of Advanced Minimally Invasive Gynecologic Surgical Procedures in The Netherlands

Abstract Study Objectives To assess the implementation of advanced laparoscopic gynecologic surgical procedures, assess the number of gynecologists performing these procedures, and highlight the distribution of surgical approaches to hysterectomy. Design Observational multicenter study. Design Classification Canadian Task Force classification II-2. Setting All hospitals in The Netherlands. Sample Minimally invasive surgical procedures performed in all 90 hospitals in the year 2012, and the number of gynecologists performing these procedures. Data were compared with national surveys conducted in 2002 and 2007. Interventions The number of advanced laparoscopic gynecologic procedures, the number of gynecologists performing these procedures, and the distribution of approaches to hysterectomy were collected through a Web-based questionnaire. Measurements and Main Results The response rate was 96% (86 of 90 hospitals). A total of 4979 advanced laparoscopic gynecologic procedures were performed in 2012 (mean per hospital, 58; median, 50.5; SD, 44.4), which is a significant increase over 2007 (95% CI, 30.3–46.5; p Conclusions Implementation of advanced laparoscopic gynecologic procedures has accelerated tremendously in the last decade, owing mainly to the increased number of laparoscopic hysterectomies. A significant shift has occurred from abdominal and vaginal hysterectomies toward a laparoscopic approach. The vaginal hysterectomy should be brought back in focus, to prevent the deterioration of skills needed to perform this least invasive approach. Furthermore, the introduction of case volume as quality assessment is sure to have consequences for daily gynecologic surgical practice in The Netherlands.