Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology

Reut Rotem, Michael O. Carey, Claire M. McCarthy, Barry A. O'Reilly, Yair Daykan*, Orfhlaith E. O'Sullivan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: This study aimed to evaluate the training and self-assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision-making, the surgical techniques employed, the training received, and the management of complications. Design: A cross-sectional survey. Setting: An electronic questionnaire. Population: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members. Methods: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries. Main Outcome Measures: Demographics, surgical selection, proficiency and technique, and training methods. Results: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two-thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10–30 cases were needed to achieve and maintain proficiency. Conclusion: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine-sparing prolapse repairs, the decision-making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques.

Original languageEnglish
Pages (from-to)205-211
Number of pages7
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume132
Issue number2
DOIs
StatePublished - Jan 2025

Keywords

  • subspecialisation
  • surgical training
  • surgical volume
  • training requirements
  • vaginal hysterectomy

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