Core Features That Contribute to Complexity at Laparoscopic Hysterectomy: An International Consensus Development Study

Abstract

<h3>Study Objective</h3> No objective, standardized language exists to characterize the complexity of a laparoscopic hysterectomy. This leads to challenges when trying to understand the relationship between patient and surgical features and post-operative outcomes. Predicting surgical complexity pre-operatively will also remain challenging if standardized complexity nomenclature does not exist. We aimed to develop a set of core features that contribute to the intra-operative surgical complexity of a laparoscopic hysterectomy. <h3>Design</h3> A consensus development study was completed via an electronic three-stage modified Delphi process. <h3>Setting</h3> International. <h3>Patients or Participants</h3> Eligible experts were identified based on specific criteria (publication record, leadership in laparoscopic surgery according to peers, active involvement in the training of advanced laparoscopic surgery, involvement with national or international organizations). <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Round one was completed by 61 experts, representing North America, South America, Europe, Africa, Asia, and Oceania. The majority had fellowship training in minimally invasive gynecologic surgery. Round two was completed by 48/61 (78.7%) experts and round three, which yielded the final consensus list of features, was completed by 46/48 experts (95.8%). Forty-two potential features were entered into round one. Ultimately, experts reached a consensus on 18 features that contribute to complexity in a laparoscopic hysterectomy that can be grouped under the following headings: 1) co-morbidities, 2) uterine size, 3) uterine fibroids; and 4) non-uterine pathology. Co-morbidities include obesity and other non-obesity co-morbidities that alter or limit the ability of a surgeon to perform the basic/routine steps in a laparoscopic hysterectomy. Non-uterine pathology includes endometriosis, ovarian cysts, and adhesions (bladder-to-uterus, rectouterine pouch, and other adhesions). <h3>Conclusion</h3> Using robust consensus science methods, an international consortium of experts have developed a set of core features that contribute to the complexity of a laparoscopic hysterectomy. This core set could be implemented in future studies that aim to assess the relationship between patient features and surgical outcomes.