Outdated surgical choices put women at risk

| May 17, 2018

Australian women are undergoing unnecessarily invasive hysterectomies due to a lack of surgical skills among gynaecologists.

Research by University of Queensland Centre for Gynaecological Cancer Research Director Professor Andreas Obermair has found many gynaecologists had not updated their skills.

“While many gynaecologists recognised the advantages of laparoscopic hysterectomy, many could not perform this procedure due to a lack of training,” Professor Obermair said.

“Overwhelming evidence suggests that laparoscopic hysterectomy has better patient and social benefits than traditional open hysterectomy.

“The procedure is associated with a shorter hospital stay, quicker recovery, better quality of life and less cost to the health care system.

“However, we found surgeons were choosing to perform open hysterectomies instead because they were very experienced in that – essentially they were comfortable doing what they’ve always done.”

Open hysterectomy involves the removal of the uterus, and potentially all reproductive organs, by a large bikini-line cut.

A laparoscopic hysterectomy is a minimally invasive keyhole surgical procedure using three or four incisions no longer than six millimetres.

Professor Obermair noted that while some gynaecologists keenly attend laparoscopy workshops, these workshops fail to provide adequate training.

“These workshops don’t really teach them how to do this operation and as specialists, there’s no regulatory need to update their surgical skills,” he said.

“A trainee learns all the time, they’re used to it, but once you’re a specialist there’s this expectation from society that you know it all.

“Existing gynaecologists are not trained in offering better alternatives – such as laparoscopic hysterectomy – because no one taught the trainers properly.”

The study has informed a program funded by the National Health and Medical Research Council aimed at updating the surgical skills of gynaecologists in Queensland.

“We are now training 10 specialists so that they are able to reduce the use of open hysterectomies and offer a less invasive alternatives like laparoscopic hysterectomies,” Professor Obermair said.

An initial test program at one hospital in the greater Brisbane area successfully saw doctors choose laparoscopic hysterectomies over open hysterectomies in the majority of cases, while surgical complication rates fell by one third.

The research was published in the Australia and New Zealand Journal of Obstetics and Gynaecology (ANZJOG).