This document summarizes an audit of gynecological ambulatory surgery cases from June 2009 to June 2011. It provides an overview of 461 total gynecology cases, with 319 being part of the personal case series. Major surgeries like vaginal and abdominal hysterectomies made up 31 cases, while the remaining 288 were other procedures like laparoscopy and D&C. Most major cases required 2 night hospital stays while other cases were same day discharge. There were 2 complications that required further intervention. Results showed patient satisfaction, good pain control and no post-operative nausea/vomiting. Two literature studies on ambulatory lap versus inpatient laparoscopic hysterectomy were summarized. The goal is to introduce

1. Ambulatory Gynecology Surgery
An Audit Of
GYNAECOLOGICAL
AMBULATORY SURGERY
Nova Medical Centers, Koramangala
1ST Jun 2009 - 30th Jun 2011
Dr Jaya Bhat
MD DGO FRCOG
September 3, 2011, Bangalore Jaya Bhat 1

2. Ambulatory Gynecology Surgery
Overview of Gynecology Cases
Total Gynecology cases :461
Gynecology No. of
Cases Surgeries
Total 461
Others,
142
Personal 319
Series
Others 142
Personal
Series,
319
September 3, 2011, Bangalore Jaya Bhat 2

3. Ambulatory Gynecology Surgery
Major surgeries : 31/319
Total Major Surgeries - 31) Major Surgeries Number : 31
17 Vaginal 17
Hysterectomy
11 Total Abdominal 11
Hysterectomy
LAVH 1
2
1 Myomectomy 2
September 3, 2011, Bangalore 3
Jaya Bhat

4. Ambulatory Gynecology Surgery
Other surgeries :258/319
Other Surgeries Number of
Other Gynaecology (258)
Cases
Laparoscopy 101
101
D&C 62
Hysteroscopy 58
MTP 29
Suction & 25 62
Evacuation 58
Mirena Insertion 6
Cervical Encirclage 3
29
25
IUCD Removal 1
6
Cervical Cautery 1 3 1 1 1 1 1
Cervical biopsy 1
Bartholin’s Abscess 1
Anterior 1
Colporraphy
September 3, 2011, Bangalore Jaya Bhat 4

5. Ambulatory Gynecology Surgery
Duration of Hospital Stay
Type of Duration
Surgery of Stay
Majors 2 nights
Others Same day
discharge
September 3, 2011, Bangalore Jaya Bhat 5

6. Ambulatory Gynecology Surgery
Complications - 2
Case 1 Case 2
Abdominal Suspected Vascular
Distension Injury
Shifted to Major
Laparotomy
Hospital
CT Scan / Normal No Major Injuries
Settled No Problems
September 3, 2011, Bangalore Jaya Bhat 6

7. Ambulatory Gynecology Surgery
Our Results
• Patients Satisfied
• Good Pain Relief
• No PONV
• Ambulatory Surgery Effective
September 3, 2011, Bangalore Jaya Bhat 7

8. Ambulatory Gynecology Surgery
Literature Survey -Study 1
Randomized Trial of
Day Care Vs Inpatient
Laparoscopic Supra cervical Hysterectomy
Jelene Kisic Trop et al; AJOG 2011: 204:307-308
Randomized – 49
In patient – 25 Day Care – 24
Objective of the Study
• Satisfaction with length of hospitalv Stay
• Quality of Life
September 3, 2011, Bangalore
8 Jaya Bhat 8

9. Ambulatory Gynecology Surgery
Literature Survey -Study 1 - Results
• Women having inpatient surgery were more
satisfied than those having a day care procedure.
Not Statistically Significant
• Quality of life Lower and Anxiety Higher
in day care group
• After 2-4 days both groups were equally satisfied
• There is need for individual choice
September 3, 2011, Bangalore Jaya Bhat 9

10. Ambulatory Gynecology Surgery
Literature Survey -Study 2
Day Surgery for Gynaecology Laparoscopy
Clinical Results for an RCT.
Claire Gudex et al: J Ambulatory Surgery;12(2006):151-157
Objective
To compare clinical outcome from inpatient
and ambulatory laparoscopy for benign gynecological condition
26 (Inpatient ) Vs 40 Ambulatory
PONV and after hospital discharge - Same
Outcome after one month – Same
September 3, 2011, Bangalore
10 Jaya Bhat 10

11. Ambulatory Gynecology Surgery
Our Goal: to Introduce
• ICD Coding
• Protocols
• Registry
September 3, 2011, Bangalore Jaya Bhat 11

12. Ambulatory Gynecology Surgery
Thank You
September 3, 2011, Bangalore Jaya Bhat 12