Quality assurance in gynecological laparoscopic and hysteroscopic surgery.Initial evaluation of data for 1997-1999 from the "quality control in operative gynecology" of Hessian clinics

The introduction and expansion of laparoscopic and hysteroscopic surgery in gynecology has aroused broad discussions among gynecologists and in the pu blic media. This stresses the necessity of quality assurance in gynecologic al surgery. Quality assurance no longer entails registration of complications during or after surgery and does not assess the medical methods themselves. This has to be done in scientific studies, evaluations, and follow-ups. Quality ass urance as practiced in the state of Hesse in Germany since 1997 is, however , very efficient in detecting trends in the use of new surgical methods. It improves medical care by questioning the indications for medical procedure s and where and how these procedures are performed. Although the system for classifying medical diagnoses and procedures is inadequate, it is possible to detect misuse in medical treatment. Clinic profiles enable clinics to c ompare their own data with others, thus facilitating clinical management. Based on the results of quality assurance for 1997 to 1999, a centralizatio n of specialized medical care (i.e., laparoscopic and hysteroscopic surgery ) can be observed. This leads to serious changes in overall clinical manage ment.