Hysterectomy is the most common major gynaecological procedure Australian women will require in their lifetimes. Yet, up to 2 in 10 patients have developed severe complications following outdated open surgery.
According to Professor Andreas Obermair, from the Queensland Centre for Gynaecological Cancer at the University of Queensland, too many women still receive open abdominal surgery in Australia.
This story is part of our 10 of the Best -Fifteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.
‘I realised that women who could have a minimally invasive, laparoscopic hysterectomy weren’t receiving them because the workforce was not up to the new surgical and technical skills standard. That’s why patients were still receiving old-fashioned, outdated surgical procedures,’ said Professor Obermair.
‘Unfortunately, there’s no systematic upskilling after Obstetricians and Gynaecologists complete their formative training.’
Professor Obermair set a goal for his NHMRC Partnerships Project: To replace open abdominal surgery by minimally invasive, laparoscopic hysterectomy for better patient outcomes and less complications. Laparoscopic hysterectomies also save the Australian public $3,000 per case.
The Implementation of MinimAlly INvasivE hysterectomy (IMAGINE) trial included developing a surgical teaching program involving a multidisciplinary team, from hospitals and health care services, charitable organisations, medical device companies and universities.
As a result of the project, Professor Obermair estimates that now about half of OBGYN surgeons are undertaking laparoscopy hysterectomies, up from about 1 in 10 only 7 years ago.
‘The number of people I talk to who are taking on more complex procedures is rapidly increasing, which is amazing. It’s fantastic.’
Professor Obermair points out that this isn’t just because of his trial, saying that hospitals, other surgeons and the Australian Gynaecological Endoscopy Society have also taken up training.
Professor Obermair was driven to improve the OBGYN field because he is acutely aware of the heartbreak that can occur as a result of poor surgical outcomes.
‘Ultimately, we want to save patients from life-altering complications. As a surgeon, you're not just “fixing up” patients, you're seeing them when they get diagnosed, you try to help them navigate the maze of decisions that they need to make. It can be a very stressful time for them because there is, for many women, a lot at stake,’ he said.
‘I think about my wife or my daughters going to hospital somewhere. They should have the confidence that the procedure recommended to them is an up-to-date procedure,’ he said.
‘I’m a fierce advocate of surgical investigator-initiated clinical trials, because that's the only way as surgeons we can actually know which procedures we should recommend to patients under what circumstances.’
‘When I started out in my career, I said that when I retire, I want to see more minimally invasive surgery than abdominal surgery. We’ve achieved that already,’ he said.
Next steps
Professor Obermair is working on expanding the training program for hysterectomies but also making the teaching framework available to other specialties.
‘I’m very excited that the framework we’ve developed can be adapted for implementing new surgical techniques in other specialties. If you wanted, for example, to implement a new way of brain surgery, liver surgery or lung surgery, then you can take this framework, adapt it to your needs and roll it out,’ he said.
CIA
Professor Andreas Obermair
Team list
Professor George B Hanna
Professor Val Gebski
Professor Nicholas Graves
Dr Saira Sanjida
Ms Caitlin Horsham
Dr Archana Rao
Professor Monika Janda
Institution
University of Queensland
Research title
The Implementation of MinimAlly INvasivE hysterectomy (IMAGINE) trial