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F W Jansen

Publications and source records attributed to F W Jansen.

At least 19 recordsLinked to original sources
PubMed2006

Implementation of the laparoscopic simulator in a gynecological residency curriculum.

BACKGROUND: In view of the current emphasis on increasing patient safety and quality control in laparoscopic surgery, there is a growing need to improve laparoscopic training. This study was conducted to investigate if and when residents reached performance standards for basic laparoscopic skills on a boxtrainer and to analyze the current state of implementation of laparoscopic simulators in a gynecological residency curriculum. METHODS: Residents across all 6 years of residency (postgraduate year [PGY] 1-6) were tested once on our boxtrainer by performing five inanimate tasks (pipe cleaner, rubber band, beads, cutting circle, intracorporeal knot tying). A sumscore for the five tasks was calculated for each participant (sum of all scores). Scores were calculated by adding completion time and penalty points, thus rewarding both speed and precision. These data were compared with scores of laparoscopic experts, which were set as performance standards. RESULTS: Of the participants, 111 were residents (7 PGY1, 27 PGY2, 29 PGY3, 28 PGY4, 14 PGY5, 6 PGY6) and 8 were experts. At the end of residency, PGY6 residents reached the performance standard for all tasks except intracorporeal knot tying. It was not until PGY5 that residents reached the performance standard for the pipe cleaner task; PGY1, for rubber band; PGY5, for beads; PGY4, for circle cutting; and PGY6, for sumscore. Throughout residency PGY6 had a mean total of only 3.6 h of simulator training experience. No correlation was found between this previous voluntary simulator training experience and performance on our boxtrainer during this study (sumscore), and between previous voluntary simulator training and total laparoscopic procedures performed. In a combined multivariate analysis, sumscore performance remained significantly associated with the number of laparoscopic procedures performed by residents when they were working as as a primary surgeon (p = 0.002), and not with the cumulative hours of simulator training during residency prior to participating in this study (p = 0.15). CONCLUSIONS: In a current Dutch gynecological residency curriculum, residents do not reach all performance standards for basic laparoscopic skills on the boxtrainer. We conclude that the voluntary simulator training program has a substantial risk to fail and that the implementation of the laparoscopic skills simulator in the current residency curriculum is in its infancy.

Female↗
PubMed2005

Gynecological laparoscopy in residency training program: Dutch perspectives.

BACKGROUND: Implementation of laparoscopy into residency training is difficult. This study was conducted to assess the current state of implementation of laparoscopic surgery into gynecological residency program, to identify factors influencing laparoscopic skills training, and to find solutions toward better training and implementation. METHODS: In 2003 a questionnaire was sent to all 68 postgraduate year 5 and year 6 residents in obstetrics and gynecology in The Netherlands. The questionnaire addressed demographics, performance of laparoscopy, self-perceived competence, simulator training, and factors influencing laparoscopic training in residency. RESULTS: Of the 68 residents, 60 (88%) responded; 46 (37%) were men and 78 (63%) women. Men showed significant higher mean self-perceived competence in some laparoscopic procedures than women. Of the respondents, 20% had no advanced laparoscopic gynecologist present in their teaching hospital. Residents felt that simulator training is important in relation to their performance in the operating room. Of all gynecological teaching hospitals in the Netherlands, 55% did not have the opportunity of simulator training. Of the respondents who had the possibility of simulator training, 33% did not use the simulator voluntarily. Residents who trained on a simulator felt training was significantly more important (p = 0.02) than residents who never practiced on a simulator. Respondents' laparoscopic skills were subjectively evaluated in the operating room (92%) or were evaluated based on the number of laparoscopic procedures performed as primary surgeon (49%). Of the respondents, 47% were satisfied with their current laparoscopic skills and 27% also felt prepared for the more advanced procedures. Not having been primary surgeon in nonacademic teaching hospitals and even more so in academic teaching hospitals (p < 0.05) was a limiting factor in acquiring laparoscopic skills. CONCLUSIONS: Incorporation of basic laparoscopic procedures into residency training has been successful; however, advanced procedures are not. Simulator training is still in its infancy in The Netherlands, is not frequently used voluntarily, and should be mandatory during residency. Acquired laparoscopic skills on a simulator and in the operating room should be objectively assessed, and above all, training of trainers is imperative.

Female↗
PubMed2004

Sonographic assessment of non-malignant ovarian cysts: does sonohistology exist?

BACKGROUND: Transvaginal ultrasound (TVU) is feasible and accurate in the differentiation between non-malignant and malignant ovarian abnormalities. However, despite the clinical relevance, the accuracy of TVU in the differentiation between the many different non-malignant cysts is unknown. METHODS: Between 1992 and 2002, all women who had surgery at our centre because of a non-malignant ovarian cyst were included prospectively in this study. The sonographic characteristics as well as the expected histological diagnosis (the 'sonohistological diagnosis') were evaluated pre-operatively. This diagnosis was compared with the histopathological diagnosis, and diagnostic parameters [with 95% confidence interval (CI)] of the sonohistological diagnosis were calculated. Logistic models, with the sonographic characteristics as variables, were constructed for each histopathological diagnosis. RESULTS: A total of 406 women were included consecutively. The overall diagnostic accuracy of the sonohistological diagnosis was 60% (95% CI 0.56-0.65). Only in cases of simple ovarian cysts did the diagnostic accuracy of the respective logistic model exceed that of the sonohistological diagnosis (0.88 versus 0.81, P < 0.01). The diagnostic accuracy of the sonohistological diagnosis for endometriotic and dermoid ovarian cysts was significantly better compared with the respective logistic model (0.84 versus 0.71, P < 0.01 and 0.87 versus 0.82, P = 0.03, respectively). CONCLUSION: In approximately half of the non-malignant ovarian cysts, TVU is capable of distinguishing between the different histopathological diagnoses of non-malignant ovarian masses. Only in the diagnosis of simple ovarian cysts might use of the logistic models be helpful.

Adolescent↗
PubMed2004

Long-term outcomes and quality of life after laparoscopic adhesiolysis for chronic abdominal pain.

STUDY OBJECTIVE: To evaluate clinical outcome in terms of pain and quality of life after laparoscopic adhesiolysis. DESIGN: Prospective observational study (Canadian Task Force II-3). SETTING: University-affiliated medical center. PATIENTS: Twenty-three patients (22 women). INTERVENTION: Laparoscopic adhesiolysis for chronic abdominal pain. MEASUREMENTS AND MAIN RESULTS: Pain was assessed by validated McGill score. Patients with an intraindividual decrease in pain score of 5 points or more were considered successes. Quality of life was assessed by the SF-36 and gastrointestinal quality of life index. Patients were evaluated before and at intervals until 2 years after adhesiolysis. The mean pain score before adhesiolysis was 30.5 (range: 17-40). At 2 years of follow-up, 10 (45%) of 22 patients (95% CI 0.244-0.678) were considered successes. They reported significant improvement in quality of life on scales physical, role physical, and social function, and fewer gastrointestinal symptoms. Twelve women (55%) had a complete relapse, and most were not motivated to visit the pain clinic after 6 months. CONCLUSION: Laparoscopic adhesiolysis for chronic abdominal pain was successful in only 45% of patients.

Abdomen↗
PubMed2003

[Efficiency of saline contrast hysterosonography for evaluating the uterine cavity].

Diagnostic hysteroscopy is the standard investigation performed in the case of abnormal vaginal blood loss. More recently there has been increasing interest for minimal invasive saline contrast hysterosonography (SCHS) as this technique is less painful and less expensive. SCHS is indicated in case of abnormal uterine bleeding (premenopausal and postmenopausal), bleeding while using tamoxifen, suspicion of a congenital uterine abnormality and Asherman's syndrome. As well as intracavity abnormalities (polyps and myomas) SCHS can also be used to evaluate the intramural extension of myomas, which is necessary to assess whether hysteroscopic resection is possible. The sensitivity and specificity of SCHS for demonstrating intracavity abnormalities (with a prevalence of 54%) are 94% (95%-CI; 91-97) and 89% (95%-CI: 85-94) respectively. The positive and negative predictive values are 91% (95%-CI: 87-95) and 92% (95%-CI: 89-97) respectively. SCHS has a short learning curve and can be performed in an outpatient setting. SCHS fails more frequently in postmenopausal women than premenopausal women (12.5% vs. 4.7%; p = 0.03). The chance of a non-conclusive SCHS is 7.6% and is higher if the uterine volume is greater than 600 cm3 (relative risk: 2.63; 95%-CI: 1.05-6.60) and if two or more myomas are present: (RR 2.65; 95%-CI: 1.16-6.10). SCHS is 2 to 9 times cheaper than diagnostic hysteroscopy. It can replace 84% of the diagnostic hysteroscopies. SCHS, in combination with endometrial sampling, whenever indicated, might be able to replace diagnostic hysteroscopy as gold standard in the evaluation of the uterine cavity.

Female↗
PubMed2003

The value of transvaginal ultrasound to monitor the position of an intrauterine device after insertion. A technology assessment study.

BACKGROUND: The intrauterine device (IUD) is an effective contraceptive method. The contraceptive power as well as the side-effects of IUD are thought to relate to the position of the IUD in the uterine cavity. We assessed the accuracy of clinical evaluation of IUD position. METHODS: A prospective comparative study was performed. The clinical evaluation was compared with the TVU measurement of IUD position both immediately after insertion and 6 weeks after insertion. The primary outcome measures were the positive and negative predictive values (PPV and NPV) of the clinical evaluation of IUD position. RESULTS: 195 women were included consecutively, 181 women (92.8%) were available for follow-up. The PPV and NPV of clinical evaluation of IUD position immediately after insertion were respectively 0.60 (95% CI: 0.39-0.81) and 0.98 (95% CI: 0.96-1.0). The prevalence of an abnormally positioned IUD was 7.7% (95% CI: 3.9-11.4). The PPV and NPV of the clinical evaluation at follow-up were respectively 0.54 (95% CI: 0.26-0.81) and 1.0 (95% CI: 0.98-1.0). The prevalence of abnormal position was 4.0% (95% CI: 1.7-7.1). CONCLUSION: Clinical evaluation is an excellent test for the evaluation of the position of an IUD and routine TVU is not indicated for this purpose.

Adolescent↗
PubMed2002

[Request for labia correction: sometimes more than a simple question].

Three women aged 19, 50 and 33 years, requested surgical correction of their labia minora because of subjective complaints attributed to the size of their labia minora. However, during consultation, for one of the patients it transpired that she did not know anything about the normal physiological changes of the external genitals during puberty and the enormous variety and diversity of the length of labia minora between women. It turned out that the other woman felt uncertain about her genitals following a recent divorce. For the third woman a vulvar pain syndrome and a sexual abuse history became clear. Two of the patients decided not to undergo surgery and the third sought a cure elsewhere. The request for a surgical correction of the labia minora seems quite simple and the operation does not seem to be complicated either. However, the question remains as to whether an operation is the solution for the psychological and behavioural consequences the woman experiences. A conservative approach is recommended, with attention for other possible problems that can be hidden behind the request for labia minora correction.

Adult↗
PubMed2001

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery.

BACKGROUND: The pneumoperitoneum is the crucial element in laparoscopic surgery. Different clinical problems are associated with this procedure, which has led to various modifications of the technique. The aim of this guideline is to define the scientifically proven standards of the pneumoperitoneum. METHODS: Based on systematic literature searches (Medline, Embase, and Cochrane), an expert panel consensually formulated clinical recommendations, which were graded according to the strength of available literature evidence. RECOMMENDATIONS: Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

Contraindications↗
PubMed2000

Complications of hysteroscopy: a prospective, multicenter study.

OBJECTIVE: To estimate the incidence of complications of diagnostic and operative hysteroscopic procedures in the Netherlands and describe their nature. METHODS: Data on complications were recorded by 82 hospitals in 1997. Participating hospitals had a 100% response rate. Any unexpected events that required intraoperative or postoperative intervention were defined as complications in two groups: approach (entry-related) and technique-related (caused by surgical instruments). RESULTS: Thirty-eight complications occurred among 13,600 hysteroscopic procedures (rate 0.28%). Diagnostic hysteroscopic procedures had a significantly lower complication rate (0.13%) than operative procedures (rate 0.95%; P <.01). Fluid overloads of distention medium were recorded five times (rate 0.20%). The most frequent surgical complication was perforation of the uterine cavity (rate 0.76%). Approximately half the perforations (18 of 33) were entry-related. Bleeding caused by perforation was seen in 0.16% of cases. Incidences of complications were: intrauterine adhesiolysis 4.48%, endometrium resection 0.81%, myomectomy 0.75%, and removal of a polyp 0.38%. CONCLUSION: Diagnostic hysteroscopic procedures had very low complication rates, so are safe procedures with which to evaluate intrauterine pathology. Operative hysteroscopic procedures were more risky, but the removal of polyps had a very low complication rate (12 times lower than synechiolysis). Half the complications were entry-related, so attention has to be paid to the method of entry with the hysteroscope (ie, no unnecessary dilation of cervix and introduction of the scope under direct vision). The other half of complications were related to surgeons' experience and type of procedure.

Female↗
PubMed1997

[Diagnostic and therapeutic dilemmas in malignancy during pregnancy].

In four pregnant women, aged 28, 29, 30, and 35, malignancies were diagnosed: synoviosarcoma, gastric carcinoma, non-Hodgkin B cell lymphoma and undifferentiated adenocarcinoma in one of the labia vulvae, respectively. The first three women eventually died, the first before giving birth, the last woman was treated surgically and was alive without recurrence two years after treatment. Pregnancy can lead to diagnostic dilemma and delay as many symptoms of a malignancy are not recognised as such but are attributed to the pregnant state and because of reluctance to apply diagnostic tools which can be harmful to the foetus. It can also lead to therapeutic dilemma and delay because several therapies may also harm the foetus.

Adult↗
PubMed1997

Complications of laparoscopy: a prospective multicentre observational study.

OBJECTIVE: To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands. DESIGN: A nationwide prospective multicentre observational study. METHODS: Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra-operative or post-operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published. RESULTS: Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [/1000]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3/1000). In 83 cases (57%; 95% CI for approach = 49-65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7/1000 for diagnostic laparoscopic procedures, 4.5/1000 for sterilisation and 17.9/1000 (chi 2 = 127; dF = 2; P < 0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy. CONCLUSIONS: Most complications occurred during operative laparoscopic procedures (rate 17.9/1000). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.

Female↗
PubMed1996

A survey on (operative) laparoscopy in The Netherlands in 1992.

OBJECTIVE: A quantitative inventory of (operative) laparoscopic surgery practiced by Dutch gynecologists in 1992 was made. METHODS: A written inquiry was mailed to all 145 departments of Obstetrics and Gynecology (including 28 teaching hospitals), where all 630 practicing gynecologists in The Netherlands are established. The questionnaire included questions about diagnostic laparoscopies, sterilizations, laparoscopy for infertility reason and operative laparoscopies. General information about follow-up training of the practitioner was also collected. All data were analyzed and comparisons were made between teaching and non-teaching hospitals. Statistical significance was calculated with the chi-square test. RESULTS: The response rate was 78%. A total of 419 respondents represented in 99 clinics reported performing 33,676 laparoscopic procedures, which makes an average of 80 procedures per physician per year. Distribution of procedures showed that 36% was for diagnostic laparoscopy, 33% for tubal sterilization, 19% laparoscopy for infertility work-up and 12% counted for therapeutic laparoscopy. Comparison of procedures in teaching hospitals (n = 27) and non-teaching hospitals (n = 72) showed only slightly more diagnostic laparoscopies for infertility in the first and more tubal-sterilizations in the latter. A statistically significant difference was found for the ring or clip sterilization in teaching hospitals, compared with the coagulation technique in non-teaching departments (P < 0.001). More difficult laparoscopic procedures such as ovarian cystectomy and conservative surgery of ectopic pregnancy were more frequently performed by those who had followed additional laparoscopic training (P < 0.02). CONCLUSIONS: The results of this survey are representative for (operative) laparoscopic practice of gynecologists in the Netherlands, because of the high response rate. Relatively, a small proportion of all laparoscopic procedures performed in 1992 are due to the therapeutic laparoscopy (12%). The great majority of therapeutic laparoscopic procedures was reported by a relatively small number of practitioners. Gynecologists who followed an additional laparoscopic training (30%) performed statistically more difficult laparoscopic procedures.

Chi-Square Distribution↗
PubMed1996

Tumor-associated eosinophilic infiltrate of cervical cancer is indicative for a less effective immune response.

The local inflammatory tumor infiltrate related to cervical carcinoma has been shown to consist mainly of T lymphocytes and macrophages. In 5% to 40% of the cases, eosinophilic granulocytes from a major part of the tumor-infiltrating cells. The presence of a high percentage of eosinophilic granulocytes in the infiltrate might reflect a less effective antitumor response, resulting in a worse overall survival. In the present study, histological slides from 83 patients who had been treated for cervical squamous carcinoma were reviewed. Special emphasis was put on the presence of eosinophils in the tumor infiltrate and correlated with clinical outcome as a parameter of the strength of the host-antitumor response. Multivariate analysis showed that the presence of a large amount of eosinophils among the infiltrate was an independent parameter, predicting a worse overall survival in patients with tumor-negative lymph nodes and tumor-negative resection margins (n = 61). The presence of eosinophilic granulocytes might represent a less appropriate immune response based on a disturbed equilibrium between Th-1- and Th-2-mediated immune response.

Adult↗
PubMed1994

Persistent cervical intraepithelial neoplasia after incomplete conization: predictive value of clinical and histological parameters.

In a group of 316 conizations performed from January 1984 to July 1991, 68 patients (22%) revealed no free margins of cervical intraepithelial neoplasia (CIN). They were divided into two groups with: 'negative follow-up' [normal cytology or less than two smears suggesting CIN I (class IIIa)] and 'positive follow-up' [at least two smears suggesting CIN I or one smear suggesting CIN II (class IIIb) or worse]. Forty-five patients (66%) fulfilled the criteria of negative follow-up. All patients with CIN I at the cone margin (18) were found in this group. The other 23 patients were in the positive follow-up group. Patients with positive follow-up were significantly younger (p = 0.04). Intervention after incomplete cone biopsy was necessary in approximately 10% (7/68) of cases. Cytology was thereby a reliable indicator for residual disease. Higher grade of CIN involved at the cone margin predicted a higher chance of positive follow-up. Semiquantitative measurement of CIN in the cone specimen showed a severe involvement of CIN II and CIN III in the positive follow-up group. In sum, our study showed that CIN I at the margin of the cone biopsy has no clinical significance. However, CIN II or III at the margin needs a careful cytologic follow-up, and appropriate action should be taken in case of cytologic abnormalities.

Adult↗