Taping endometriosis surgery

by Lone Hummelshoj, Ros Wood and Philippe Koninckx MD PhD

Surgery is a well accepted treatment for endometriosis, yet quality control mechanisms that ensure that any surgery is carried out safely and effectively are almost entirely absent.

Quality control in drug treatment

Before a new drug treatment can be introduced, the drug must undergo a special type of testing known as a randomised controlled trial (RCT). In an RCT, each person is randomly given one of two treatments: one group is given the new drug; the other group is given an ‘old’ drug whose effects are well known, or a placebo (‘dummy’ sugar pill).

At the end of the trial, the results of the two treatments are compared. The comparison provides doctors with a reliable measure of the new drug’s efficacy (how well it works) and side effects compared with the ‘old’ drug or no drug. The new drug is released only if the trials show that it is an effective and safe treatment.

Quality control in endometriosis surgery

However, the situation is not so simple for surgery. A woman’s surgery depends on the locations and extent of her endometriotic lesions, and the skill, experience, and expertise of the surgeon. Therefore, each woman’s surgery is different. As a result, evaluating the effectiveness and side effects of surgery is almost impossible, because you do not have two standard treatments to compare.

In addition, it is generally considered unethical to carry out randomised controlled trials for surgery, because the trial would involve some of the women having ‘proper’ surgery (having their endometriosis removed, etc), and others having ‘sham’ surgery (simply going in and out with a laparoscope, but not removing any endometriosis, etc).

Possible control mechanisms

So, how can you or anybody else check that a surgeon is capable of competently doing the surgical procedures necessary to treat your endometriosis?

Accreditation* of surgeons could be one solution. But, unlike airline pilots and air traffic controllers, who have to adhere to strict operating procedures (with an enviable safety record!), there are no agreed standards as to what the accreditation checkpoints should be or who would provide the accreditation when it comes to surgery.

* Accrediation = an official recognition/certification that certain standards are met

Video taping as a solution

A simple solution would be for surgeons to video-tape every woman’s surgery from beginning to end, and to give each woman a copy of the recording of her surgery [1]. (She wouldn’t need to watch the recording, but should keep it for future reference.)

The recording would document the surgery, including any mistakes. If there were complications following the surgery, it would be easy for the surgeon — or another surgeon — to look at the tape and see what happened during the procedure. If they found any problems, they could deal with a complication quickly and efficiently.

The video-tape could also be used to ascertain that the surgery was performed accurately, meticulously and precisely, and whether anyapparent complications were due to inadequate surgery.

If there was symptoms recurrance after surgery, the surgeon could go back to the video-tape to see if all the lesions had been removed, and thus determine whether current symptoms were due to the emergence of new lesions or a recurrence of old lesions.

Taping should be mandatory

Today, there is no excuse for not video-taping every endometriosis surgery. Doing so would ensure that there is a quality control mechanism for endometriosis surgery. CDs and DVDs allow the information to be stored and retrieved easily. Watermarking of the video-tape would allow it to be validated at a later date if necessary.

Surgeons who refuse to provide their patients with a video-tape of their surgery may not be confident of their ability to perform the very best surgery. This inaction provides ‘quality control’ of a sort. Unless surgeons are prepared to record their work, they will never be able to provide the necessary quality control to show that their surgery is an effective and successful treatment for most women with endometriosis.

Always ask your surgeon whether they will video-tape your surgery, and whether you can have a copy of the tape. If they refuse, you need to decide whether you have confidence in their ability to provide you with the best surgical care — after all, a good surgeon has nothing to hide.

Reference
  1. Koninckx PR. Videoregistration of surgery should be used as a quality control. JMIG 2008;15(2):248-253.
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