Gynaecologist & Endoscopic Surgeon

Surgical Experience and Complications

 

SURGICAL EXPERIENCE

The following table includes all major procedures since 1995. Some minor procedures have been omitted. Since the database has been running A/Prof Cooper has performed about 97% of operations without a large abdominal incision.

Commentary on these results is provided here.

 

The following results are current as at end March 2017:

Total

Operative Laparoscopy

Diagnostic Laparoscopy

Excision of Endo

Major Vaginal

Abdominal

Bowel Resection

10423
5030
457
1674
656
153
388
  48% 4% 16% 6% 2% 4%

 
Endometriosis Surgery Results

Total

Severe

Moderate

Mild

Bowel Resection

1674
693
646
335
388

 

Procedure Number %
Total excision of endometriosis
1674
 
Including endometrioma (ovarian chocolate cyst)
388
25
Incuding bowel resection
388
23
Unplanned repeat endometriosis surgery
137
9
No endometriosis found
50
3
Endometriosis present at repeat surgery
87
6
Repeat surgery for endometrioma (cyst) recurrence  (%/initial endometrioma)
28
2
Overall hysterectomy  (endometriosis patients)
106
7

Please note that the above results should be interpreted with caution. It is possible that the reoperation rates reflects a lower number than reality as some patients may have had repeat surgery of which A/Prof Cooper is not aware.

 

Complications

  May-17    
All procedures 10423    
Laparoscopy      
  Operative 5030    
  Diagnostic 457    
  5487    
       
Endometriosis 1674    
Bowel resection 388    
       
Significant complications      
       
Vascular damage requiring laparotomy 3 3/5487 0.05%
       
Bowel issue req laparotomy 14 14/5487 0.26%
   Overall stoma 12 12/5487 0.22%
   Planned bowel lap stoma endo 6 6/1674 0.36%
   Unplanned stoma endo 4 4/1674 0.24%
   Unplanned stoma no endo 2 2/5487 0.04%
   Fistula spontaneously healed 1 1/5487 0.02%
       
Bladder requiring laparotomy 3 3/5487 0.05%
    Endo  1 1/1674 0.06%
       
Ureteric surgery  (all endo) 12 12/1674 0.72%
    Delayed recognition 2 2/1674 0.12%
    Intraop repair stent etc 10 10/1674 0.60%
    Prophylactic stent 5 5/1674 0.30%
       
Take back to OT 29 29/10423 0.28%
       
Overall major complication requiring laparotomy 38 38/10423 0.36%
    Rate per laparoscopy 35 35/5487 0.64%
    Endo cases per laparoscopy 13 13/1674 0.78%

 

Major Laparoscopic Complications#** Published Rate Cooper’s Rate
death 0.06/1000** 0
major complication 5.23/1000** 6.4/1000
excision of endometriosis   7.8/1000

# Major defined as those requiring laparotomy
** Querleu et al, “Complications of gynaecological laparoscopic surgery” Gyn Endoscopy 1993 2, 3-6

 

RANZCOG CLINICAL INDICATORS

(For 6 months to end of June 2013 – see here for guidelines and definitions.  Institution data tracked elsewhere). (Previous 6 month rolling rates are listed in brackets, starting end 2011).

Further commentary on these complications listed here.

  • CI 1.1 Blood transfusion 1/131 0.8% (Historic 0.4, 1.6, 1.1%)
  • CI 2.1 Major viscous damage (excludes laparoscopy) 0/0 0% (Historic 0, 6.7, 0%)
  • CI 3.1 Injury to major viscous (only laparoscopy) 1/91 1% (Historic 0.6, 0, 0.8%)
  • CI 3.2 Ureter injury at laparoscopic hysterectomy 0/8 0% (Historic 0, 0, 0%)
  • CI 3.3 Bladder injury at laparoscopic hysterectomy 0/8 0% (Historic 0, 0, 0%)

 

PLEASE NOTE

Many of A/Prof Cooper’s patients are referred from other gynaecologists and require procedures such as bowel surgery. These patients are at higher surgical risk than uncomplicated patients.

He is happy to discuss his complication profile and provide further information.

       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
Facebook feed
1 year ago
How Does Surgical Volume Affect Gynecologic Surgery Outcomes?

More evidence that low volume surgeons have more problems: https://t.co/gw77JTNAao

Dr Kaunitz suggests an honest self-assessment of our experience level when planning for surgical care of our patients.

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