Why has the acceptance of laparoscopic hysterectomy been slow? Results of an anonymous survey of Australian gynecologists

Study objective: To determine whether Australian gynecologists would like to increase the proportion of hysterectomies they perform laparoscopically and the factors that might limit their acceptance of laparoscopic hysterectomy (LH). Design: Anonymous postal survey (Canadian Task Force classification III). Setting: Department of obstetrics and gynecology of a major Australian medical school. Participants: Seven hundred ninety-six certified obstetrician/gynecologists in practice in Australia. Main Results: Of 796 respondents, 654 (82%) reported that hysterectomy was part of their normal clinical practice. Of those, 206 (31%) did not perform LH. Respondents who reported performing the highest proportion of LH were those in urban, private hospital settings. Of those who performed hysterectomy, 62% (403/654) reported they did not wish to increase the proportion of LH they undertook. However, of those, 49% (197/403) already performed LH, with 20% (39/197) of that group performing 80% or more of all hysterectomies as LH. Overall, 38% (251/654) of respondents indicated a desire to perform an increased proportion of LH. The commonest factors cited as limited acceptance of LH were insufficient experience and training, lack of hospital equipment, and lack of support from colleagues. Conclusion: Many Australian gynecologists report a desire to increase their rate of LH, but those intentions are compromised by problems with training, equipment, and support.