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.

The following results are current as at end September 2018:

Procedure

Number

%

Total excision of endometriosis 1766
Including endometrioma (ovarian chocolate cyst) 447 25
Incuding bowel resection 403 23
Unplanned repeat endometriosis surgery 149 8
No endometriosis found 52 3
Endometriosis present at repeat surgery 97 5
Repeat surgery for endometrioma (cyst) recurrence  (%/initial endometrioma) 28 2
Overall hysterectomy  (endometriosis patients) 127 7

SURGICAL EXPERIENCE

Procedure

Number

Operative Laparoscopy 5289
Diagnostic Laparoscopy 494
Excision of Endometriosis 1776
Major Vaginal
Abdominal
Bowel Resection 403
Total Hysterectomy 557

ENDOMETRIOSIS SURGERY RESULTS

Caution should be taken when interpreting this information. A/Prof Cooper’s practice is biased towards more complex cases and includes over 400 cases of bowel resection. Complications are more likely in this group of patients. A/Prof Cooper believes his complication rate is appropriate and not excessive. All surgical procedures carry a degree of risk. Individual circumstances vary considerably and need to be assessed before contemplating surgery.

 

Complications

Number

%

Vascular damage at laparoscopy requiring laparotomy 3 0.05
Bowel issue requiring laparotomy 15 0.26
Overall stoma 13 0.22
Planned bowel stoma endometriosis 6 0.34
Unplanned stoma endometriosis 5 0.28
Unplanned stoma no endometriosis 2 0.03
Fistula spontaneously healed 1 0.02
Bowel repair no laparotomy 12 0.21
Bladder requiring laparotomy 3 0.05
Endometriosis 1 0.06
Ureteric surgery (all endometriosis) 15 0.84
Delayed recognition 3 0.17
Intraop repair stent etc 12 0.68
Take back to OT 31 0.28
Overall major complication 39 0.35
Rate per laparoscopy 36 0.62
Endo cases per laparoscopy 14 0.79

Number

Severe 733
Moderate 689
Mild 354
Bowel Resection 403

COMPLICATIONS

Click to read commentary on these results

Commentary on Procedures and Complications to end of September 2018.

The tables display all procedures and major complications to the end of September 2018. It should be noted that considerable care should be taken when interpreting these numbers. Associate Professor Cooper operates on a large number of patients with significant endometriosis and the risk profile of this group of patients for complications is higher than the general population. Secondly he may not be aware of some complications and as such these figures may under represent the true numbers.

Since commencing practice as a specialist gynaecologist in 1995 Associate Professor Cooper has undertaken over 10,000 operative procedures. He has performed over 5,500 laparoscopies most being of an operative rather than a diagnostic nature. Over the last 10-15 years his practice has predominantly moved towards endometriosis and he has performed over 1,700 interventions for the excision of endometriosis. Of these at the time of writing 403 have had bowel resections of various forms of being performed. These procedures represent the most difficult and complex of gynaecological surgery including cancer. The significant complications and issues are listed in the table.

There were 3 significant vascular complications all of which were treated by immediate laparotomy and oversewing of various vessels.

Fourteen patients required laparotomy to deal with some form of issue involving the bowel. There was an overall colostomy rate of 13 with a rate of 0.2% of all laparoscopies. Eleven of the stomas related to patients with endometriosis and 6 of these were planned intra-operatively with a rate of 0.36% per endometriosis patient. Five unplanned stomas were performed in the post operative period at a rate of 0.24% Two patients who had procedures unrelated to endometriosis required stomas with an overall rate of 0.04%. An additional patient with endometriosis had a recto-vaginal fistula which healed spontaneously (0.02%).

Three patients required laparotomy for bladder injuries (0.05%) and of these 1 patient had endometriosis (0.06%).

Fifteen patients required some form of intervention in relation to the ureter. All of these patients had endometriosis as an underlying condition. Delayed recognition of the injury occurred in 3 patients (0.12%) and 10 required some form of intra-operative repair or stent. Five stents were placed as prophylaxis to ensure against a possible leak in the post operative period.

Thirty one patients had to return to theatre with an overall rate of 0.28%. These included the 3 bladder and 4 bowel patients mentioned above and a patient who sustained a delayed leak from a ureter ultimately resulting in a uretero-colic fistula. Other issues included 8 post operative bleeds, 7 abscesses and infected areas, 2 patients who ultimately had no abnormality detected, 1 patient with a small bowel obstruction following a bowel resection, 1 omental herniation at a trocar site, 1 perforation at a hysteroscopic myomectomy, a vault dehiscence in a patient who initiated sexual activity in the early post operative period following a hysterectomy, a recurrent Bartholin’s abscess and 1 patient who had a microscopic needle identified in the recovery room following laparoscopic tubal reversal with a needle which had initially been counted as outside the patient.

There were no patient deaths. The overall major complication rate was 0.35% (39/11126). The rate per laparoscopy was 0.62% (36/5783). Specifically for endometriosis cases the rate was 0.79% (14/1776).

Associate Professor Cooper believes this complication profile is appropriate for the type of surgery he performs and is happy to discuss this analysis.