The importance of analyzing and standardizing surgical methods.

The outcome of operations performed in different institutions or by different surgeons can hardly be compared if the operative methods are not standardized. Six different vaginal hysterectomy methods were studied. The steps common in all of them were defined. These steps were analyzed for optimal performance and sequence during the operation. The resultant modified method was subjected to a prospective randomized study, which showed that the operation time and the need for pain drugs were reduced. A prospective randomized study was performed at the University Hospital of Perugia, Italy. After the introduction and demonstration of the method, 44 women underwent the 10-step vaginal hysterectomy and were compared with 52 women who underwent the Heaney method. For simplicity it was decided to use only 1 method in the control group to prevent heterogeneity. Both the operation time and the need for pain drugs were significantly reduced in the women who underwent the modified operation (p ,.05) . No significant difference existed in either group concerning age or duration of hospital stay.Thismethod was introduced to several departments in different countries. The optimization and standardization of surgical methods are expected not just to improve the postoperative outcome, but also to enable a comparison between different departments and surgeons.