Understanding Limits of Parametrial Resection in Radical Hysterectomy: A Randomized Controlled Trial Volume 4 - Issue 2

Fortunato Genovese¹, Stefano Siringo¹*, Attilio Tuscano², Francesco Cannone³, Vito Leanza¹, Francesco Cosentino⁴, Stefano Palomba² and Marco Palumbo¹

• ¹Institute of Obstetric and Gynecologic Pathology, Department of Surgery, San Marco Hospital, University of Catania, Italy
• ²UOC of Obstetrics and Gynaecology, GOM. Bianchi-Melacrino-Morelli, Italy
• ³Division of Obstetrics and Gynaecology, Italy
• ⁴UOC Gynecology Oncology, Gemelli Molise, Università Cattolica Sacro Cuore, Italy

Received: December 07, 2020   Published: December 17, 2020

Corresponding author: Stefano Siringo, Institute of Obstetric and Gynecologic Pathology, Department of Surgery, San Marco Hospital, University of Catania, Catania, Italy

DOI: 10.32474/OAJOM.2020.04.000184

 

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Abstract

Objective: It is well known that the complexity of pelvic anatomy, although the large number of educational resources, sometimes makes it difficult for gynaecologists, not trained in surgical oncology, to understand operations performed for oncological indications. The purpose of this study is to evaluate if adding specific educational materials (medical illustrations realized ad hoc) to the reading comprehension alone of the latest Querleu-Morrow Classification of radical hysterectomy (2017) may help Ob-Gyn residents and general ob-gyn attendings to better understand limits of parametrial resection in radical hysterectomy from type A to type C2.

Study Design: randomized controlled trial.

Setting: Institute of Obstetric and Gynecologic Pathology, University of Catania, Italy.

Materials and methods: 30senior Ob/Gyn residents and 30 general Ob/Gyn attending were enrolled to the study, and randomly allotted in two groups, each made up by an equal number [15] of residents and attending, defined as group A and group B. The group A and B participants were both given copy of the article (2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy) for reading comprehension. The group B participants, were given, beside the copy of article, 10 inedited medical illustrations, realized on the basis of this paper, as an educational aid to enhance the reading comprehension of the article. After a maximum of 1 month, allowed to both groups to review article and/or article and drawings, the level of self-perceived understanding related to parametrectomy limits in radical hysterectomy was ascertained in both groups using a numeric visual analog scale, graduated from 0to 10, where each participant was asked to rate his degree of comprehension. The data obtained were statistically analyzed using a Mann-Whitney U test.

Results: Group A participants (only article) had a lower level of comprehension of parametrectomy limits compared to group B participants (article plus drawings). The difference between the average scale score, reported by group A, equal to 5,9±1,4 and that reported by group B, equal to 7,2 ±1,5 was statistically significant (p< 0,01).

Discussion and Conclusions: The result of the present study, suggest, that beside the large body of Literature on the subject, educational materials such as , the proposed drawings may help both the general Ob/Gyn , to whom the patient may return for follow up after surgery and the Ob/Gyn resident, who is still in the learning process, to better comprehend the relationship between the extent of parametrial resection and cervical disease severity, and therefore the related post operative complications and long term sequelae.

Keywords: Radical Hysterectomy; Parametrium; Paracervix; Parametrectomy; Subperitoneal Spaces; Numeric Visual Analog Scale; Understanding; Pelvic Anatomy; Terminologia Anatomica

Abstract| Introduction| Materials and Methods| Results| Discussion| Conclusion| References|