|Camera trocar lifting in laparoscopy.|
|Office surgery, Office prolapse surgery, Office laparoscopy, Office TVT surgery|
The Small Town, The Big Town, The King And His Palace
A short story from some time ago
In the year of 1992, an office setting was established in a small town hospital. At first only uncomplicated operations were performed (abortion, exploratory curettage, hysteroscopy, conization, laser surgery), later more complicated operations (thermal endometrial destruction, gasless laparoscopic sterilization/open access technique, TVT-incontinence surgery) and from 1997 office prolapse surgery.
In a few years time (1998), 63% of all operations were performed using local anesthesia and mild sedation, including 50 of 96 prolapse surgeries. Waiting times for surgery had decreased (-80%) from a mean of 6 weeks to 1 week - except for hysterectomy (4 weeks). Health care spending had decreased (-22%) and gynecological inpatient and outpatient services had increased (+29%).
Then, in the big town where the King lives in his palace, The National Board Professors of Health and Welfare stated that “Prolapse surgeries under local anesthesia are suboptimal procedures where economics are prioritized and not the interests of patients”. The small town office setting for surgery under local anesthesia and mild sedation was told to restrict its procedures to cystoscopy and curettage.
Not so many years later (2007) a big hospital, in the same big town where the King lives, was nominated to a prize-award for excellent improvement in healthcare with the motivation: "The nominees have eliminated traditional, not evidence-based routines in connection with prolapse-surgery. With surgery under local anesthesia women can be operated on faster, easier and with shorter waiting times. The patients are mobilized and leave for home in the same day. A traditionally large operation has been transformed into a minimal-invasive procedure”.
Prolapse surgery under local anesthesia that, in the last year of the last millennium, was considered to be a bad and blameworthy procedure had become a praised and excellent piece of work.
Even National Board professors can misjudge a new procedure.