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1628 Use of Fundamentals Of Laparoscopic Surgery (FLS) Testing to Assess Gynecologic Surgeons: 10 Years of Experience
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Interventions: Voluntary participation in a 58-item survey Measurements and Main Results: We received 158 survey responses with 84 (53.2%) responses coming from 4th year residents and 74 (46.8%) responses from 3rd year residents. The majority of resident respondents graduated from an allopathic medical school (139; 88%), identify as female (129, 81.6%), and are attending an Academic-University based program (96, 60.8%). The majority of respondents (67.7%) have not and do not plan on applying for a surgical fellowship in Ob/Gyn. Overall, the majority of residents (71.5%) feel their residency training adequately prepared them to be a competent minimally invasive surgeon. However, only 50% feel prepared to perform a laparoscopic hysterectomy on a uterus greater than 12 weeks size, and 12% feel prepared to offer a laparoscopic hysterectomy for a uterus above the umbilicus. Less than one-third of residents (29%) feel prepared to offer a vaginal hysterectomy on a uterus 12week size or greater, and only 17% of residents feel comfortable performing a laparoscopic myomectomy. For endometriosis surgery 76% of senior residents do not feel prepared to offer excisional surgery. Of the residents not interested in a surgical fellowship 45% do not plan on referring complex gynecologic cases to a fellowship trained minimally invasive surgeon. Conclusion: The overwhelming majority of senior U.S. Ob/Gyn residents do not feel prepared to provide minimally invasive surgery for complex gynecologic cases. Despite this discomfort nearly half of these residents do not plan on referring their patients to a competent minimally invasive surgeon.
Conclusion: Overall, both OBGYN and surgery residents had a high FLS pass rate. The manual skills test scores were comparable between specialties, but the cognitive scores were lower for OBGYN compared to surgery providers. Further investigation regarding validity of the cognitive component of the FLS exam for OBGYN providers may be warranted.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION F 1628 Use of Fundamentals Of Laparoscopic Surgery (FLS) Testing to Assess Gynecologic Surgeons: 10 Years of Experience Seaman SJ,1,* Jorgensen EM,2 Tramontano AC,3 Jones DB,4 Mendiola M,2 Ricciotti H,2 Hur HC1. 1Obstetrics and Gynecology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, NY; 2Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3 Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA; 4Surgery, Beth Israel Deaconess Medical Center, Boston, MA *Corresponding author. Study Objective: To assess Fundamentals of Laparoscopic Surgery (FLS) exam scores among OBGYN and general surgery providers. Design: This is a descriptive study of all FLS examinees in OBGYN and general surgery and at a single academic institution (Beth Israel Deaconess Medical Center [BIDMC], Boston, MA) from July 2007 to May 2018. We compared categorical and continuous variables with Chi-square, t, and Wilcoxon rank-sum tests. Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements and Main Results: 205 BIDMC trainees and faculty took the FLS exam between July 2007 and May 2018 of which 176 were identified to be OBGYN or general surgery providers. The FLS pass rate was high for both specialties (98.7% OBGYN, 99.0% surgery, p= 0.42). When comparing providers in OBGYN and general surgery, no difference was found in manual skills score (mean 594.9 OBGYN vs 601.0 surgery, p=0.59), however, a significant difference was noted in the cognitive scores with surgery providers scoring higher than OBGYN providers (mean 533.8 OBGYN vs 583.4 surgery, p=0.0003). In a multivariate linear regression model adjusting for specialty, level of training, age, sex, and test year, none of the variables were significant predictors for manual scores. However, age, sex, and test year were predictors for cognitive scores with greater scores associated with younger age, male sex, and advancing calendar year. Surgical specialty was not a predictor for manual or cognitive scores.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION G 2382 Pelvic Sidewall Anatomy and Vasculature Miller B,1,* Gore E,2 Giglio A,2 ElSahwi K1. 1Gynecologic Oncology, Hackensack Meridian Health, Neptune, NJ; 2Obstetrics and Gynecology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ *Corresponding author. Video Objective: To demonstrate lateral pelvic wall spaces and anatomy Setting: da Vinci Robotic Platform dissection during a hysterectomy procedure Interventions: A dissection of the para-rectal space, the para-vesical space, the obturator fossa, and the space of Morrow. Demonstration of a step by step dissection plan and dissection techniques. Identifying the main branches of the anterior division of the internal iliac artery as well as the inferior hypogastric nerve plexus and the obturator nerve Conclusion: This video will help the trainee follow a roadmap of the lateral pelvic sidewall dissection and the identification of structures necessary for the safe and effective completion of malignant and complex benign surgical procedures. Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION H 1222 Conservative Management of Cesarean Scar Pregnancies with Systemic Multidose Methotrexate: Predictors of Treatment Failure and Reproductive Outcomes Levin G,1,* Dior UP,2 Shushan A,3 Benshushan A,2 Rottenstreich A1. 1 Departments of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel; 2Department of Obstetrics and Gynecology, HadassahHebrew University Medical Center, Ein-Kerem, Jerusalem, Israel; 3 Hadassah Medical Center, Jerusalem, Israel *Corresponding author. Study Objective: The role of conservative management of CSP has been previously reported with conflicting results reported. In this retrospective study, we aimed to further evaluate its role and better delineate the subsequent reproductive outcomes Design: A retrospective cohort study. Setting: A large university hospital (Hadassah Medical Center Hospitals, Israel, Jerusalem) between November 2014 to April 2017 Patients or Participants: All patients diagnosed with a CSP and treated by intention of conservative management with systemic methotrexate (MTX). Interventions: A comparison of maternal and gestation characteristics was performed between treatment success and failure groups Measurements and Main Results: Thirty seven cases of CSP were encountered. Overall, 29/37 (78.3%) were treated by systemic injection of MTX while the other 21.7% had combined systemic and local (i.e. intrasac) MTX treatment. Invasive intervention was needed in 5 (13.5%) cases (failure group). Cases who were converted to surgical treatment had higher number of previous cesarean deliveries (median 4 vs. 2, p=0.002). In logistic regression modeling, the number of prior cesarean deliveries in the past was the only factor found independently associated with conversion to surgical management Odds Ratio 2.02, 95 % Confidence Interval 1.03,3.94.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Interventions: Voluntary participation in a 58-item survey Measurements and Main Results: We received 158 survey responses with 84 (53.2%) responses coming from 4th year residents and 74 (46.8%) responses from 3rd year residents. The majority of resident respondents graduated from an allopathic medical school (139; 88%), identify as female (129, 81.6%), and are attending an Academic-University based program (96, 60.8%). The majority of respondents (67.7%) have not and do not plan on applying for a surgical fellowship in Ob/Gyn. Overall, the majority of residents (71.5%) feel their residency training adequately prepared them to be a competent minimally invasive surgeon. However, only 50% feel prepared to perform a laparoscopic hysterectomy on a uterus greater than 12 weeks size, and 12% feel prepared to offer a laparoscopic hysterectomy for a uterus above the umbilicus. Less than one-third of residents (29%) feel prepared to offer a vaginal hysterectomy on a uterus 12week size or greater, and only 17% of residents feel comfortable performing a laparoscopic myomectomy. For endometriosis surgery 76% of senior residents do not feel prepared to offer excisional surgery. Of the residents not interested in a surgical fellowship 45% do not plan on referring complex gynecologic cases to a fellowship trained minimally invasive surgeon. Conclusion: The overwhelming majority of senior U.S. Ob/Gyn residents do not feel prepared to provide minimally invasive surgery for complex gynecologic cases. Despite this discomfort nearly half of these residents do not plan on referring their patients to a competent minimally invasive surgeon.
Conclusion: Overall, both OBGYN and surgery residents had a high FLS pass rate. The manual skills test scores were comparable between specialties, but the cognitive scores were lower for OBGYN compared to surgery providers. Further investigation regarding validity of the cognitive component of the FLS exam for OBGYN providers may be warranted.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION F 1628 Use of Fundamentals Of Laparoscopic Surgery (FLS) Testing to Assess Gynecologic Surgeons: 10 Years of Experience Seaman SJ,1,* Jorgensen EM,2 Tramontano AC,3 Jones DB,4 Mendiola M,2 Ricciotti H,2 Hur HC1. 1Obstetrics and Gynecology, Columbia University Irving Medical Center - New York Presbyterian Hospital, New York, NY; 2Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3 Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA; 4Surgery, Beth Israel Deaconess Medical Center, Boston, MA *Corresponding author. Study Objective: To assess Fundamentals of Laparoscopic Surgery (FLS) exam scores among OBGYN and general surgery providers. Design: This is a descriptive study of all FLS examinees in OBGYN and general surgery and at a single academic institution (Beth Israel Deaconess Medical Center [BIDMC], Boston, MA) from July 2007 to May 2018. We compared categorical and continuous variables with Chi-square, t, and Wilcoxon rank-sum tests. Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements and Main Results: 205 BIDMC trainees and faculty took the FLS exam between July 2007 and May 2018 of which 176 were identified to be OBGYN or general surgery providers. The FLS pass rate was high for both specialties (98.7% OBGYN, 99.0% surgery, p= 0.42). When comparing providers in OBGYN and general surgery, no difference was found in manual skills score (mean 594.9 OBGYN vs 601.0 surgery, p=0.59), however, a significant difference was noted in the cognitive scores with surgery providers scoring higher than OBGYN providers (mean 533.8 OBGYN vs 583.4 surgery, p=0.0003). In a multivariate linear regression model adjusting for specialty, level of training, age, sex, and test year, none of the variables were significant predictors for manual scores. However, age, sex, and test year were predictors for cognitive scores with greater scores associated with younger age, male sex, and advancing calendar year. Surgical specialty was not a predictor for manual or cognitive scores.
Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION G 2382 Pelvic Sidewall Anatomy and Vasculature Miller B,1,* Gore E,2 Giglio A,2 ElSahwi K1. 1Gynecologic Oncology, Hackensack Meridian Health, Neptune, NJ; 2Obstetrics and Gynecology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ *Corresponding author. Video Objective: To demonstrate lateral pelvic wall spaces and anatomy Setting: da Vinci Robotic Platform dissection during a hysterectomy procedure Interventions: A dissection of the para-rectal space, the para-vesical space, the obturator fossa, and the space of Morrow. Demonstration of a step by step dissection plan and dissection techniques. Identifying the main branches of the anterior division of the internal iliac artery as well as the inferior hypogastric nerve plexus and the obturator nerve Conclusion: This video will help the trainee follow a roadmap of the lateral pelvic sidewall dissection and the identification of structures necessary for the safe and effective completion of malignant and complex benign surgical procedures. Virtual Poster Session 2: Basic Science/Research/Education (1:20 PM − 1:30 PM) 1:20 PM: STATION H 1222 Conservative Management of Cesarean Scar Pregnancies with Systemic Multidose Methotrexate: Predictors of Treatment Failure and Reproductive Outcomes Levin G,1,* Dior UP,2 Shushan A,3 Benshushan A,2 Rottenstreich A1. 1 Departments of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel; 2Department of Obstetrics and Gynecology, HadassahHebrew University Medical Center, Ein-Kerem, Jerusalem, Israel; 3 Hadassah Medical Center, Jerusalem, Israel *Corresponding author. Study Objective: The role of conservative management of CSP has been previously reported with conflicting results reported. In this retrospective study, we aimed to further evaluate its role and better delineate the subsequent reproductive outcomes Design: A retrospective cohort study. Setting: A large university hospital (Hadassah Medical Center Hospitals, Israel, Jerusalem) between November 2014 to April 2017 Patients or Participants: All patients diagnosed with a CSP and treated by intention of conservative management with systemic methotrexate (MTX). Interventions: A comparison of maternal and gestation characteristics was performed between treatment success and failure groups Measurements and Main Results: Thirty seven cases of CSP were encountered. Overall, 29/37 (78.3%) were treated by systemic injection of MTX while the other 21.7% had combined systemic and local (i.e. intrasac) MTX treatment. Invasive intervention was needed in 5 (13.5%) cases (failure group). Cases who were converted to surgical treatment had higher number of previous cesarean deliveries (median 4 vs. 2, p=0.002). In logistic regression modeling, the number of prior cesarean deliveries in the past was the only factor found independently associated with conversion to surgical management Odds Ratio 2.02, 95 % Confidence Interval 1.03,3.94.