The main objectives of this thesis are to obtain clinically relevant tools to evaluate quality during the introduction of new interventions in laparoscopic hysterectomy (LH) (the most frequently... Show moreThe main objectives of this thesis are to obtain clinically relevant tools to evaluate quality during the introduction of new interventions in laparoscopic hysterectomy (LH) (the most frequently performed advanced gynecological minimally invasive procedure) and to support clinicians to ensure surgical safety by means of process analysis. We performed a Delphi study to achieve consensus on a uniform and multidisciplinary applicable definition. Based on this definition, we described the relevance, evidence and controllability of conversion rate as a means of evaluation in LH. We performed a systematic review with cumulative analysis to evaluate the outcomes of abdominal, laparoscopic and vaginal hysterectomy (VH) in patients with a BMI ≥35kg/m2 and concluded that the feasibility of LH and VH should be considered prior to the abdominal approach to hysterectomy in these patients. Furthermore, we performed a prospective study using video observation, to assess the incidence and effect of equipment-/instrument-related surgical flow disturbances during LH and validated a questionnaire to detect potential safety hazards during the introduction of new interventions in an early stage. Finally, the Digital Operating Room Assistance (DORA) model was introduced which is a novel system for automated procedural progress monitoring that enables prediction of the remaining procedure duration. Show less
The aim of the thesis was to identify clinically relevant topics within the field of minimally invasive gynecology and to formulate best practices for them.
Women__s knowledge of medicinal plants has largely been understudied in the field of ethnobotany. In addition to this gender bias, most ethnobotanical research has focused on the expert knowledge... Show moreWomen__s knowledge of medicinal plants has largely been understudied in the field of ethnobotany. In addition to this gender bias, most ethnobotanical research has focused on the expert knowledge of traditional healers, overlooking the domestic knowledge of women. This is a particular concern for African women__s knowledge of reproductive health and childcare, since gynecological morbidity and infant mortality are among the most severe health problems in African countries. This dissertation sought to unravel the relationship between women and plants by assessing women__s medicinal plant knowledge and plant use practices for reproductive health and childcare in B_nin, West Africa and Gabon, Central Africa. Through the use of ethnobotanical questionnaires, botanical specimen collection, and herbal market surveys this study assesses (1) which types of vegetation women harvest for medicinal plants, (2) how closely women__s health perspectives, plant knowledge, and plant use practices reflect the statistical causes of maternal mortality (3) which infant illnesses mothers know how to treat with medicinal plants and for which illnesses they seek biomedical care or traditional healers, and (4) which species, volume, and value of medicinal plant products are sold on herbal markets in Gabon Show less
The development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially... Show moreThe development of gynecological laparoscopy in The Netherlands is slow. Laparoscopic training needs more emphasis during residency training. The laparoscopic simulator needs to be officially implemented into residency curriculum guidelines and incorporated into practice. Simulator training should be structured and mandatory, as a training tool, as well as a skills assessment tool. In order for residents to obtain a sufficient and uniform level of skills, their surgical skills need to be measured individually and objectively by means of the simulator. In addition, experts' level on the simulator can be set as performance standards for residents and should be reached by residents before performing live laparoscopic surgery. Assisting during laparoscopic hysterectomy should be added to the requirements for graduation in the curriculum guidelines. To accomplish these recommendations, skilled laparoscopic gynecologists are required in every teaching hospital. Besides the beneficial aspects for residency training, a skilled laparoscopic gynecologist is needed to establish an internal referral system for procedures such as laparoscopic hysterectomy. For the other advanced laparoscopic procedures a regional or national referral system can be created. Show less
