HWR Schreuder

• MD PhD Associate Professor
• Gynaecologic Oncologist at University Medical Center Utrecht

Background Treatment of newly diagnosed advanced-stage ovarian cancer typically involves cytoreductive surgery and systemic chemotherapy. We conducted a trial to investigate whether the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery would improve outcomes among patients who were receiving neoadjuvant...

Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons. To review the literature on training and learning strategies for robotic assisted laparoscopic surgery. A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery w...

Over the past decade, there has been an exponential growth of robot-assisted procedures and of publications concerning robotic-assisted laparoscopic surgery. From a review of the available literature, it becomes apparent that this technology is safe and allows more complex procedures in many fields of surgery, be it at relatively high costs. Althou...

To obtain face and construct validity for a new training course to be used in any type of box/video trainer and to give a comprehensive overview of validated exercises for box/video training. Cross-sectional study. University Medical Centre. Students, residents and consultants. Participants (n = 42) were divided into three groups according to their...

To estimate face and construct validity for a novel curriculum designed for intermediately skilled laparoscopic surgeons on a virtual reality simulator. It consists of 5 exercises that focus on training precision and coordination between both hands. Prospective study (Canadian Task Force II-2). Three university hospitals and 4 teaching hospitals in...

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in patients with Stage III ovarian cancer following interval cytoreductive surgery (CRS). Optimising patient selection is essential to maximise treatment efficacy and avoid overtreatment. This study aimed to identify biomarkers that predict HIPEC benefit by analysing g...

Introduction/Background In March 2019, interval cytoreductive surgery (ICS) with hyperthermic intraperitoneal chemotherapy (HIPEC) became the standard of care for FIGO stage III ovarian cancer patients treated with neo-adjuvant chemotherapy in the Netherlands. The OVHIPEC-1 trial showed a bowel resection rate of 23% in both arms, with a significant...

(Abstracted from Lancet Oncol 2023;24:P1109–P1118) Although the 5-year survival of patients with advanced ovarian cancer has improved, overall survival at 10 years remains approximately 13%. Hyperthermic intraperitoneal chemotherapy (HIPEC) involves the delivery of chemotherapeutic agents directly into the peritoneum in combination with hyperthermi...

5509 Background: The randomized, phase 3 OVHIPEC-1 trial (NCT00426257) investigated the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery in patients with stage III epithelial ovarian cancer who were ineligible for primary cytoreduction. OVHIPEC-1 previously demonstrated improved recurrence-free and ove...

Objective Gestational Trophoblastic Diseases (GTD) comprise a group of rare diseases originating from the trophoblast, affecting women of child-bearing age. Providing optimal information to patients with a rare disease is challenging, because of the small number of patients and limited clinical expertise of many healthcare professionals. Both knowl...

Introduction This study assessed the incidence, severity and risk factors for pain after abdominal mesh usage in pelvic floor prolapse surgery. Methods Prospective observational cohort study (NCT01598467, clinical trials.gov) performed in a tertiary referral center for patients with gynecological prolapse. Women undergoing robot-assisted sacrocolp...

Background There is a growing need for genetic testing of women with epithelial ovarian cancer. Mainstream genetic testing provides an alternative care pathway in which non-genetic healthcare professionals offer pre-test counseling themselves. We aimed to explore the impact of mainstream genetic testing on patients’ experiences, turnaround times an...

The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin to interval cytoreductive surgery improves recurrence‐free (RFS) and overall survival (OS) in patients with stage III ovarian cancer. Homologous recombination deficient (HRD) ovarian tumors are usually more platinum sensitive. Since hyperthermia impairs BRCA1/2 protein...

Objective: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is standard of care in the Netherlands in patients with stage III epithelial ovarian cancer following interval cytoreductive surgery (CRS). Differences in patient selection, technical aspects, and perioperative management exist between centers performing HIPEC. Standardization aims to red...

Introduction/Background* Gestational Trophoblastic Diseases (GTD) comprise a group of rare diseases originating from the trophoblast, affecting women of child-bearing age. Providing optimal information to patients with a rare disease is challenging, because of the small number of patients and limited clinical expertise of many healthcare profession...

Objective Decrease in skeletal muscle index (SMI) during neoadjuvant chemotherapy (NACT) has been associated with worse outcome in patients with advanced ovarian cancer. To validate these findings, we tested if a decrease in SMI was a prognostic factor for a homogenous cohort of patients who received NACT in the randomized phase 3 OVHIPEC-trial. M...

University Medical Centre Utrecht, Netherlands Introduction Previous learning curve studies are focused on short term surgical outcomes of robot-assisted surgery. We are the first to study the influence of learning curve on recurrence rate and quantify its impact on survival in patients with early stage cervical cancer using a validated analysis....

Introduction Hyperthermic intraperitoneal chemotherapy (HIPEC) improved investigator-assessed recurrence-free survival and overall survival in patients with stage III ovarian cancer in the phase III OVHIPEC-1 trial. We analyzed whether an open-label design affected the results of the trial by central blinded assessment of recurrence-free survival,...

Background. To determine face and construct validity for the new Bimanual Fundamentals curriculum for the Simendo® Virtual Reality Laparoscopy Simulator and prove its efficiency as a training and objective assessment tool for surgical resident’s advanced psychomotor skills. Methods. 49 participants were recruited: 17 medical students (novices), 15...

Objective: To investigate the learning curve of robot-assisted laparoscopy in early stage cervical cancer and quantify impact on oncological outcomes. Design: Observational cohort study. Setting: Tertiary referral centre with one surgical team. Population: All early stage cervical cancer patients treated consecutively with robot-assisted lap...

Study Objective: To determine face- and construct validity for the new ‘Bimanual Fundamental Curriculum’ for the Simendo Virtual Reality Laparoscopy Simulator and prove efficiency as a training and objective assessment tool for surgical resident’s advanced psychomotor skills. Design: Prospective multi-center cohort study. Power calculation was pe...

Study Objective: To evaluate residents’ opinion and to establish face- and content validity of a new silicone pelvic model for gynecologic simulation box training to practice technical and procedural laparoscopic skills. Intended innovative features of this model are: a realistic design made of silicone (i.e. realistic gynecological anatomy and fee...

Introduction/Background Skeletal muscle depletion in women with advanced ovarian cancer has been associated with adverse clinical outcome and survival. To validate earlier results in a homogenous population, we analyzed whether a decrease in skeletal muscle index (SMI) during neo-adjuvant chemotherapy (NACT) is associated with worse outcome in pati...

(Abstracted from J Clin Oncol 2019;37:2041–2050) Despite advancements in treatment modalities, the 10-year survival rate of women diagnosed with advanced-stage ovarian cancer has remained between 10% and 15% for the past 20 years. This is in part due to the majority of cases being diagnosed when disease has reached International Federation of Gynec...

Purpose: In the randomized open-label phase III OVHIPEC trial, the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) improved recurrence-free and overall survival in patients with stage III ovarian cancer. We studied the cost effectiveness of the addition of HIPEC to interval CRS in patients with...

Introduction The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) improves recurrence-free (RFS) and overall survival (OS) in patients with FIGO stage III ovarian cancer. We evaluated the effect of HIPEC on patient’s health-related quality of life (HRQoL) in the OVHIPEC trial. Materials and meth...

Background: Determination of the learning curve of new techniques is essential to improve safety and efficiency. Limited information is available regarding learning curves in robot assisted laparoscopic pelvic floor surgery. Objective: To assess the learning curve in robot-assisted laparoscopic pelvic floor surgery. Study Design: Prospective co...

A 44-year-old previously healthy woman was admitted to the hospital with complaints of acute abdominal pain, anorexia, and sweating, which started one week prior to admission. An abdominal computerized tomography (CT) scan revealed a mass in the left ovary (10 x 14 cm), a second mass in the left adrenal gland (5 x 6 cm) and massive ascites througho...

Objectives: To provide a systematic overview of the literature assessing the value of haptic and force feedback in current simulators teaching laparoscopic surgical skills. Data sources: The databases of Pubmed, Cochrane, Embase, Web of Science, and Google Scholar were searched to retrieve relevant studies published until January 31st, 2017. The...

Background: Robotic camera holders for endoscopic surgery have been available for 20 years but market penetration is low. The current camera holders are controlled by voice, joystick, eyeball tracking, or head movements, and this type of steering has proven to be successful but excessive disturbance of surgical workflow has blocked widespread intr...

(Abstracted from N Engl J Med 2018;378:230–240) The majority of patients with ovarian cancer (OC) receive an initial diagnosis of advanced disease that has spread from the ovaries to the peritoneal surface. The most effective treatment for patients with advanced disease is cytoreductive surgery followed by systemic chemotherapy.

Case Report: Degenerative Cervical Leiomyoma Resembling Malignant Leiomyosarcoma.

Study objective: To assess improvement of cognitive surgical knowledge of laparoscopic hysterectomy in post-graduate year (PGY) 1 and 2 gynecology residents who used an interactive computer-based Laparoscopic Hysterectomy Trainer. Design: Multicenter prospective, randomized, controlled study (Canadian Taskforce Classification I). Setting: Five...

NVMO 2017 The Medical Exibition Seminar: Implementatie en evaluatie van een nieuwe onderwijsvorm voor klinisch redeneren en monodisciplinair overleg. Auteurs: Schreuder HWR, Slijkhuis M, ten Cate O, Wijnen-Meijer M. Context/probleemstelling Tijdens de opleiding tot arts zijn klinisch redeneren en monodisciplinair overleg belangrijke competenties. I...

Background: In the OVHIPEC study (NCT00426257), the addition of HIPEC to interval cytoreductive surgery (CRS) significantly improved recurrence-free (HR 0.66, 95% CI 0.50-0.87) and overall survival (HR 0.67, 95% CI 0.48-0.94) in patients with stage III ovarian cancer. We report the results of the health-related quality of life (HRQOL) analysis of p...

Background Cytoreductive surgery and systemic therapy are essential for newly diagnosed ovarian cancer. We conducted a multicenter phase 3 trial to study whether the addition of intraperitoneal chemotherapy under hyperthermic conditions (HIPEC) to interval cytoreductive surgery would improve outcome among patients receiving neo-adjuvant chemotherap...

Background: Medical students often do not feel prepared to manage emergency situations after graduation. They experience a lack of practical skills and show significant deficits in cognitive performance to assess and stabilize trauma patients. Most reports in the literature about simulation-based education pertain to postgraduate training. Simulat...

Introduction: The following research questions were answered: (1) What are the training pathways followed by the current robot professionals? (2) Are there any differences between the surgical specialties in robot training and robot use? (3) What is their opinion about multidisciplinary basic skills training? Methods: An online questionnaire was...

Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer...

Objective: Serious games are new in the field of laparoscopic surgical training. We evaluate the residents׳ opinion of a new laparoscopic simulator for the Nintendo Wii-U platform. Design: Prospective questionnaire study. Participants received a standardized introduction and completed level 3 and 4 of the game "Underground." They filled out a qu...

Benign metastasising leiomyoma (BML) is a rare benign disease associated with uterine leiomyoma and history of uterine surgery. It most frequently occurs in premenopausal woman, with a pulmonary localisation, and consisting of multiple nodules. We present an uncommon case of a 69-year-old woman with a single BML of an inguinal lymph node. CT scans...

Purpose: Therapeutic vaccination with human papillomavirus type 16 (HPV16) E6 and E7 synthetic long peptides (SLP) is effective against HPV16-induced high-grade vulvar and vaginal intraepithelial neoplasia (VIN/VaIN). However, clinical nonresponders displayed weak CD8⁺ T-cell reactivity. Here, we studied if imiquimod applied at the vaccine site cou...

Objective: To identify factors contributing to the occurrence of unintended pregnancies after Essure sterilization in the Netherlands. Even though Essure is a permanent method of contraception, unintended pregnancies have been reported. Design: Retrospective case series analysis. Setting: Not applicable. Patient(s): Thirty-five pregnancies w...

Videoabstract

OBJECTIVE: During laparoscopic surgery distractions often occur and multitasking between surgery and other tasks, such as technical equipment handling, is a necessary competence. In psychological research, reduction of adverse effects of distraction is demonstrated when specifically multitasking is trained. The aim of this study was to examine whet...

Objective. To determine residents’ opinion about a new portable box trainer, to see if they would be interested in using this for training at home, and to give an overview of the box trainers that could be used at home. Methods. An expert opinion study was performed among 27 gynecology residents to determine the value of the portable box trainer in...

The objective of this retrospective descriptive study was to assess overall survival and disease free survival of patients treated for epithelial ovarian cancer by a gynaecologic-oncologist in a single Dutch peripheral teaching hospital and to identify independent prognostic factors. A retrospective series of 242 patients treated for epithelial ova...

Objectives: To assess the current state of laparoscopic gynecologic surgery in the Dutch residency program, the level of competence among graduated residents, and whether they still perform these procedures. Furthermore, their current attitudes toward the implementation of minimally invasive surgery into residency training were assessed. Design:...

Aims With the exponential growth of robotic surgery the need for validated training tools for robot assisted laparoscopic surgery is increasing rapidly. There is a growing need for reliable assessment tools in robotic surgery. These tools need to be implemented in competence based training curricula. Methods A Pubmed-Medline search was performed fr...

Study Objective To evaluate whether hysteroscopy training in the Dutch gynecological residency program is judged as sufficient in daily practice, by assessment of the opinion on hysteroscopy training and current performance of hysteroscopic procedures. In addition, the extent of progress in comparison with that of the residency program of a decade...

Objective During laparoscopic surgery distractions often occur and multitasking between surgery and other tasks, such as technical equipment handling, is a necessary competence. In psychological research, reduction of adverse effects of distraction is demonstrated when specifically multitasking is trained. The aim of this study was to examine wheth...

Chondosarcoma of the proximal femur is a rare malignant disorder in women of (pre-) childbearing age, for which a radical resection through a hemipelvectomy could be indicated. We describe a case of a 36-year-old primigravida with a hemipelvectomy (2004) who had a history of radiotherapy of the pelvic and uterine regions after an atypical cartilagi...

Vesicovaginal fistulas are a rare complication of hysterectomy. When conservative therapy fails, vaginal or abdominal repair is necessary. A robotic-assisted laparoscopic approach can be a useful tool to repair complex fistulas. A 50-year-old woman with a vesicovaginal fistula located at the top of the vagina, was treated with robotic-assisted lapa...

The introduction of robot assisted laparoscopic surgery has revolutionized the field of minimal invasive surgery. This new technique is growing fast and is nowadays used within most of the surgical specialties.The rapid introduction of robotic procedures necessitates new training methods. The robotic system seems ideal for integrating various forms...

This study investigated a possible correlation be-tween training of camera navigation skills with a 30° optic in hysteroscopy and laparoscopy by exploring whether 30° cam-era navigation training in hysteroscopy provides a certain level of expertise in laparoscopic camera navigation. If a correlation exists, training models and programs in gynecolo-...

Objective: With the increase in robotic-assisted laparoscopic surgery there is a concomitant rising demand for training methods. The objective was to establish face and construct validity of a novel virtual reality simulator (dV-Trainer, Mimic Technologies, Seattle, WA) for the use in training of robot-assisted surgery. Methods: A comparative co...

Despite the upcoming use of hysteroscopy and increased applicability during the last decades, little work has been done regarding the development of hysteroscopic training models in comparison to laparoscopy. Camera navi-gation is often perceived to be an easy task, but it is far from an innate ability, especially when an angled optic is used. This...

Background. Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents, operating room nurses, and medical studen...

We report a case of a young woman presenting with abdominal pain due to a rare and recurrent herniation of the ovary, to a retroperitoneal location lateral to the external iliac artery and directly dorsal to the iliopsoas muscle. Correlation between computed tomography, magnetic resonance imaging and laparoscopy is presented. The patient's complain...

- In the University Medical Center Utrecht, the Netherlands, robot-assisted surgical procedures are performed weekly within the departments of Surgery, Gynaecology and Urology.- Training for robot-assisted minimally invasive surgical procedures can be divided into two parts: system training and procedure training. After completing training modules,...

To assess the learning curve using a virtual reality simulator for hysteroscopic sterilization with the Essure method. Prospective multicenter study (Canadian Task Force classification II-2). University and teaching hospital in the Netherlands. Thirty novices (medical students) and five experts (gynecologists who had performed >150 Essure steriliza...

Objective: To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands. Design: Prospective multicenter study (Canadian Task Force II-2). Setting: Ten community (teaching) hospitals in the Netherlands. Patient(s): A total of 631 women who underwent permanent sterilization...

Purpose: To evaluate dosimetric parameters and clinical outcome for cervical cancer patients treated with chemo-radiation and MR-image guided adaptive brachytherapy (MR-IGABT) using tandem-ovoid applicators for intracavitary or combined intracavitary/interstitial approaches. Method: This retrospective analysis includes 46 patients treated betwee...

This study investigated the validity of a virtual reality simulator for hysteroscopic tubal sterilization. Initially performed laparoscopically, the hysteroscopic sterilization method is becoming increasingly popular. An adequate training model could enhance one’s skills prior to the start of performing the procedure on the real patient. This prosp...

In today’s medical education environment, surgical training is severely compromised by several issues including: fewer surgeries performed; shorter work hours; fewer years of clinical experience. Currently, learning to perform surgery utilizes: non-surgical laparoscopic skills exercises, simulation and actual operating room experience. Clearly, add...

In teaching hospitals all over the world, skills laboratories have been set up in order to train and assess minimally invasive surgical (MIS) skills. However, there are no generally accepted standards as to what an MIS skills laboratory should look like and how the training should be conducted. This study is an attempt to develop an international a...

Malignant ovarian germ cell tumor is a rare disease, but with current treatment strategies including surgery and platinum based chemotherapy survival is excellent. After treatment, intensive followup is indicated to encounter tumor relapse at an early stage. This case describes a 22-year-old female with a history of common variable immune deficienc...

Serum concentrations of CA-125 are rarely elevated beyond 1000 U/ml in benign conditions of the ovary in postmenopausal women. In this report, the authors present an unusual case of a 78-year-old woman with an extremely elevated CA-125 concentration of 2897 U/ml without the presence of a malignancy, ascites or pleural effusion. Imagin...

Study Objective: In today’s medical education environment, surgical training is compromised by a variety of issues including: fewer surgeries performed; shorter hours; fewer years of clinical experience. Currently, learning to perform surgery utilizes: laparoscopic skills exercises; simulation; actual operating room experience. Clearly, additional...

Objective: The purpose of this study is to investigate the diagnostic accuracy of 3.0Tesla (3T) diffusion-weighted magnetic resonance imaging (MRI) in addition to conventional MRI for the detection of lymphadenopathy in patients with early stage cervical cancer compared to histopathological evaluation of the systematically removed pelvic lymph nod...

We assessed the effect of increasing experience of a single surgeon (learning curve) in the laparoscopic staging procedure for women with early ovarian cancer and compared the results with the literature. We retrospectively analysed a total of 25 women with apparent early-stage ovarian cancer who underwent a laparoscopic staging procedure by the sa...

Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surg...

Validation of a Novel Virtual Reality Simulator for Robotic Surgery Schreuder HW,1 Wolswijk RG,1 Persson JE,2 Ihse I,3 Schijven MP,4 Verheijen RH.1 1. Department of Gynecologic Oncology, University Medical Centre Utrecht, Utrecht, Netherlands 2. Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden 3. Department of Surg...

Objective To obtain face and construct validity for a new training course to be used in any type of box/video trainer and to give a comprehensive overview of validated exercises for box/video training. Design Cross-sectional study. Setting University Medical Centre. Population Students, residents and consultants. Methods Participants (n = 42) were...

A 64-year-old woman with recurrence of carcinoma of the vulva in an irradiated area received an en-bloc total pelvic exenteration. Reconstruction of the pelvic defect was performed with an anterolateral thigh (ALT) flap and a rectus abdominis muscle (RAM) flap (PM/RAM). This combination of flaps is unique, with excellent results. In a large defect,...

Cases of cervical carcinoma metastasing to the transposed ovary are rarely reported in the literature. In this report, the authors present the case of a 53-year-old woman with a persisting, unsuspected cyst in the right transposed ovary, 10 years after treatment for adenosquamous carcinoma of the cervix. It is the first report describing a secondar...