D Papoutsis1, P Kandanearachchi1, A Antonakou2, C Tzavara3, B Sahu1. 1. Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, United Kingdom. 2. Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Greece. 3. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece.
Abstract
BACKGROUND: We aimed to determine whether continuous auditing of the presumed depth of excision and comparing with the actual depth of excision in women having large loop excision of the transformation zone (LLETZ) improves the ability to acquire the desired depth of excision. METHODS: This was a prospective study of women submitted to a single LLETZ treatment between 2017-2018. Two senior colposcopists recorded what they presumed was the depth of excision at the time of treatment and the subsequent histopathology report provided the actual excised depth. Multiple linear regression identified independently associated parameters with the difference between presumed and actual excision depth. Non-linear regression determined the learning plateau defined as the theoretical minimal score of difference one could achieve with infinite practice. RESULTS: There were significant differences in practices with the first colposcopist using an 18-mm loop and the second colposcopist a 15-mm loop in the majority of cases. The median absolute and percentage difference between the presumed and actual excised depth was 2 mm and 16.6 % and 3.5 mm and 35.4 % for the two colposcopists, respectively. A learning plateau was identified only for the first colposcopist. We found that auditing consecutive excisions decreased significantly the difference between the presumed and actual depth of excision with a learning plateau at 2.2 mm of absolute difference and 22.6 % of percentage difference and with a learning rate of 13 cervical excisions. CONCLUSION: There might be a benefit in auditing our treatment practice as there seems to be a learning plateau through this method. HIPPOKRATIA 2018, 22(3): 113-121. Copyright 2018, Hippokratio General Hospital of Thessaloniki.
BACKGROUND: We aimed to determine whether continuous auditing of the presumed depth of excision and comparing with the actual depth of excision in women having large loop excision of the transformation zone (LLETZ) improves the ability to acquire the desired depth of excision. METHODS: This was a prospective study of women submitted to a single LLETZ treatment between 2017-2018. Two senior colposcopists recorded what they presumed was the depth of excision at the time of treatment and the subsequent histopathology report provided the actual excised depth. Multiple linear regression identified independently associated parameters with the difference between presumed and actual excision depth. Non-linear regression determined the learning plateau defined as the theoretical minimal score of difference one could achieve with infinite practice. RESULTS: There were significant differences in practices with the first colposcopist using an 18-mm loop and the second colposcopist a 15-mm loop in the majority of cases. The median absolute and percentage difference between the presumed and actual excised depth was 2 mm and 16.6 % and 3.5 mm and 35.4 % for the two colposcopists, respectively. A learning plateau was identified only for the first colposcopist. We found that auditing consecutive excisions decreased significantly the difference between the presumed and actual depth of excision with a learning plateau at 2.2 mm of absolute difference and 22.6 % of percentage difference and with a learning rate of 13 cervical excisions. CONCLUSION: There might be a benefit in auditing our treatment practice as there seems to be a learning plateau through this method. HIPPOKRATIA 2018, 22(3): 113-121. Copyright 2018, Hippokratio General Hospital of Thessaloniki.
Entities:
Keywords:
CIN; LLETZ; audit; intraepithelial neoplasia; large loop excision of the transformation zone; learning curve; learning plateau
Authors: Marc Arbyn; Charles W E Redman; Freija Verdoodt; Maria Kyrgiou; Menelaos Tzafetas; Sadaf Ghaem-Maghami; Karl-Ulrich Petry; Simon Leeson; Christine Bergeron; Pekka Nieminen; Jean Gondry; Olaf Reich; Esther L Moss Journal: Lancet Oncol Date: 2017-11-07 Impact factor: 41.316