Published online Mar 20, 2023. doi: 10.5662/wjm.v13.i2.18
Peer-review started: October 30, 2022
First decision: January 20, 2023
Revised: February 2, 2023
Accepted: February 13, 2023
Article in press: February 13, 2023
Published online: March 20, 2023
It is well known that urinary tract injury is a complication of hysterectomies. There have been many studies that aim to determine if surgeon volume has an impact on the incidence urinary tract injury during hysterectomies. However, no studies have compared subspecialists to general gynecologists when assessing the incidence of urinary tract injury.
Urinary tract injury increases morbidity for patients who undergo hysterectomy. Subspeciality training and surgeon volume are factors that should be assessed when determining the incidence of urinary tract injury in an effort to decrease patient morbidity.
Our primary outcome was the incidence of urinary tract injury between fellowship trained board-certified female pelvic medicine and reproductive surgery surgeon, fellowship trained board eligible or board-certified gynecologic oncology surgeons, and board-certified or board eligible general gynecologists. Our secondary outcome was the incidence of urinary tract injury between high (defined by 30 or more minimally invasive hysterectomies per year) and low-volume surgeons (defined by less than 30 hysterectomies per year).
We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. All patients who underwent the following surgeries with or without concomitant procedures were included: Laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy, total laparoscopic hysterectomy, and robotic hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon’s volume per year was calculated. Univariable analysis of factors associated with surgeon type and ureteral injury were assessed using Student’s t-test, ANOVA followed by multiple pairwise comparisons using the Bonferroni correction of the P value, and the χ2 analysis. Non-parametric tests were performed for data that were non-normally distributed, such as the Mann-Whitney U test and Kruskal-Wallis test.
Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. Bowel injury occurred in three (3%) of patients in the gynecologic oncologist group and there were none in the general gynecologist and urogynecologist groups. There were no cases of major vessel injury.
When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group when looking at complications aside from urinary tract, bowel, or major vessel injury.
To our knowledge, this was the first study to look at differences in urinary tract injury rates in general gynecologists vs subspecialists. This study provides a guide for further and more widespread studies to be performed to investigate if a difference truly exists.