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1307 Ureterolysis: Preventing Ureteral Injury during Robotic Hysterectomy
S156
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
acceptability of proposed interventions will be analyzed in a recurring fashion as part of a Plan-Do-Study-Act (PDSA) cycle. Conclusion: A multi-disciplinary approach to improving operating room efficiency allowed for sharing of responsibility and improved communication between team members. Engagement of all stakeholders is fundamental to ensuring accurate analysis of current process flow and successful deployment of QI strategies. This process mapping exercise can be easily applied to other surgical procedures and expanded for use in surgical teaching and education.
Video Objective: To demonstrate successful ureterolysis technique when the ureter is abutting the cervix. Setting: A 43 year-old multiparous woman with an enlarged fibroid uterus and abnormal uterine bleeding desired definitive surgical management. Her right ureter was abutting the cervix to within less than 0.5cm and required meticulous dissection to maintain its integrity. Interventions: Several factors are considered to maintain ureteral integrity during hysterectomy. These include: 1- Identification and dissection of the ureter along the medial leaflet of the broad ligament; 2- In-depth knowledge of the anatomical variations of the parametric; 3- Judicious use of monopolar and bipolar electrosurgery; 4- In-depth understanding of the various effects of electrosurgery on tissues. Conclusion: Understanding the course of the ureter is crucial during hysterectomy. When abutting the cervix, judicious use of monopolar and bipolar energy is key to maintain ureteral integrity.
Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION K 1988 Improving the Utility of The Manufacturer and User Facility Device Experience (MAUDE) Database: Using Categorization of Device Events to Compare Uterine Endometrial Ablation Devices Woo JJ,1,* Johnson ME,2 Kahn BS1. 1Department of Gynecological Surgery, Scripps Clinic, La Jolla, CA; 2Virginia Commonwealth University School of Medicine, Richmond, VA *Corresponding author. Study Objective: Categorize 13 years of FDA MAUDE reports on endometrial ablation devices to assess its utility as an improvement to the database. Design: The MAUDE database was reviewed from 2005 to 2018 using brand name searches: Genesys HTA, HerOption, Minerva, Novasure, and Thermachoice. Events related to device malfunction with and without patient injury were categorized: Type I: non-injury equipment malfunction event, Type II: an injury event not requiring hospitalization and, Type III: an injury event requiring hospitalization. Setting: 13-year FDA MAUDE database review (2005-2018). Patients or Participants: N/A Interventions: N/A Measurements and Main Results: 1518 MAUDE reports were categorized as follows: Genesys HTA: Type I: 131/432(33.41%), Type II: 259/ 432 (58.1%), Type III: 42/432 (9.49%); HerOption: Type I: 4/14 (28.57%), Type II: 0 (0%), and Type III:10/14 (71.43%); Minerva: Type I: 13/56 (23.21%), Type II: 9/56 (16.07%), and Type III: 34/56 (60.71%); Novasure: Type I: 92/550 (16.7%), Type II: 273/550 (49.6%), Type III: 185/550 (33.6%); Thermachoice: Type I: 315/466 (67.60%), Type II: 78/ 466 (16.74%), and Type III: 73/466 (15.67%). Large differences in reported category type were noted between brands of instruments. Conclusion: The MAUDE database serves as a valuable tool for physicians to evaluate the safety of medical devices. Patient injuries, minor and serious, are critical information physicians need when considering new device use. Categorizing MAUDE reports into 1) instrument malfunction, 2) minor patient injury & 3) major patient injury (i.e., hospitalization) is a potential way to make the database more useful. While the MAUDE system was not design to compare devices, the categorization proposed here demonstrates a potential method to do this and improve the utility of the database. Additionally, the absence of sales or use volume data on devices use is a serious limitation to the utility of the database. This data can and should be incorporated into the MAUDE reporting system. Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION L 1307 Ureterolysis: Preventing Ureteral Injury during Robotic Hysterectomy Clarizio K,* Elkattah RA. Obstetrics and Gynecology, University of Illinois College of Medicine Peoria, Peoria, IL *Corresponding author.
Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION M 1846 Preparing for FLS: A Survey of Residents in Obstetrics and Gynecology Porter AE,1,* Chang S,2 Fuller T,3 Kho KA4. 1Obstetrics & Gynecology, UT Southwestern, Dallas, TX; 2UT Southwestern, Dallas; 3UT Southwestern, Dallas, TX; 4Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX *Corresponding author. Study Objective: Fundamentals of Laparoscopic Surgery (FLS) is a validated curriculum that uses laparoscopic simulation to prepare surgeons for the operating room. The American Board of Obstetrics and Gynecology has made FLS certification an eligibility requirement to take the certifying board exam for residents graduating in 2020 and onwards. The objective of this study is to describe the resident experience and to quantify test preparation for the FLS exam. Design: This is a prospective observational study at a large academic medical center. Setting: This study took place at UT Southwestern Medical Center between September 1, 2018 and March 31, 2019. Patients or Participants: Second year residents in Obstetrics and Gynecology were invited to participate in the study if they had completed their initial FLS certification exam. Of 18 second year residents, 15 met eligibility criteria and all agreed to participate. Interventions: Participants completed a two-page questionnaire about their preparation for the exam, including questions about practice time and repetitions for the five skills tasks and time spent watching the FLS-provided videos. Measurements and Main Results: 15 residents completed the survey. Participants spent an average of 3 sessions practicing for an average of 23 hours per task. 11/15 residents rated the ligating loop the easiest task to master and 8/15 residents rated the precision cut most difficult. Residents viewed the training modules an average of 1.7 times. All 15 residents who took the exam passed. Conclusion: FLS certification will soon be a requirement of all graduating US residents in Obstetrics & Gynecology. Residents and training programs will benefit from an understanding of the time and resources required to successfully take this exam. Our data suggests that residents spent upwards of 10 hours practicing to proficiency on the simulation tasks, in addition to viewing the training videos. Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION N 3028 Peer-Coaching Effect On Laparoscopic Surgical Skills Amongst OB/GYN Residents. A Quality Improvement Randomized Controlled Study
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
acceptability of proposed interventions will be analyzed in a recurring fashion as part of a Plan-Do-Study-Act (PDSA) cycle. Conclusion: A multi-disciplinary approach to improving operating room efficiency allowed for sharing of responsibility and improved communication between team members. Engagement of all stakeholders is fundamental to ensuring accurate analysis of current process flow and successful deployment of QI strategies. This process mapping exercise can be easily applied to other surgical procedures and expanded for use in surgical teaching and education.
Video Objective: To demonstrate successful ureterolysis technique when the ureter is abutting the cervix. Setting: A 43 year-old multiparous woman with an enlarged fibroid uterus and abnormal uterine bleeding desired definitive surgical management. Her right ureter was abutting the cervix to within less than 0.5cm and required meticulous dissection to maintain its integrity. Interventions: Several factors are considered to maintain ureteral integrity during hysterectomy. These include: 1- Identification and dissection of the ureter along the medial leaflet of the broad ligament; 2- In-depth knowledge of the anatomical variations of the parametric; 3- Judicious use of monopolar and bipolar electrosurgery; 4- In-depth understanding of the various effects of electrosurgery on tissues. Conclusion: Understanding the course of the ureter is crucial during hysterectomy. When abutting the cervix, judicious use of monopolar and bipolar energy is key to maintain ureteral integrity.
Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION K 1988 Improving the Utility of The Manufacturer and User Facility Device Experience (MAUDE) Database: Using Categorization of Device Events to Compare Uterine Endometrial Ablation Devices Woo JJ,1,* Johnson ME,2 Kahn BS1. 1Department of Gynecological Surgery, Scripps Clinic, La Jolla, CA; 2Virginia Commonwealth University School of Medicine, Richmond, VA *Corresponding author. Study Objective: Categorize 13 years of FDA MAUDE reports on endometrial ablation devices to assess its utility as an improvement to the database. Design: The MAUDE database was reviewed from 2005 to 2018 using brand name searches: Genesys HTA, HerOption, Minerva, Novasure, and Thermachoice. Events related to device malfunction with and without patient injury were categorized: Type I: non-injury equipment malfunction event, Type II: an injury event not requiring hospitalization and, Type III: an injury event requiring hospitalization. Setting: 13-year FDA MAUDE database review (2005-2018). Patients or Participants: N/A Interventions: N/A Measurements and Main Results: 1518 MAUDE reports were categorized as follows: Genesys HTA: Type I: 131/432(33.41%), Type II: 259/ 432 (58.1%), Type III: 42/432 (9.49%); HerOption: Type I: 4/14 (28.57%), Type II: 0 (0%), and Type III:10/14 (71.43%); Minerva: Type I: 13/56 (23.21%), Type II: 9/56 (16.07%), and Type III: 34/56 (60.71%); Novasure: Type I: 92/550 (16.7%), Type II: 273/550 (49.6%), Type III: 185/550 (33.6%); Thermachoice: Type I: 315/466 (67.60%), Type II: 78/ 466 (16.74%), and Type III: 73/466 (15.67%). Large differences in reported category type were noted between brands of instruments. Conclusion: The MAUDE database serves as a valuable tool for physicians to evaluate the safety of medical devices. Patient injuries, minor and serious, are critical information physicians need when considering new device use. Categorizing MAUDE reports into 1) instrument malfunction, 2) minor patient injury & 3) major patient injury (i.e., hospitalization) is a potential way to make the database more useful. While the MAUDE system was not design to compare devices, the categorization proposed here demonstrates a potential method to do this and improve the utility of the database. Additionally, the absence of sales or use volume data on devices use is a serious limitation to the utility of the database. This data can and should be incorporated into the MAUDE reporting system. Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION L 1307 Ureterolysis: Preventing Ureteral Injury during Robotic Hysterectomy Clarizio K,* Elkattah RA. Obstetrics and Gynecology, University of Illinois College of Medicine Peoria, Peoria, IL *Corresponding author.
Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION M 1846 Preparing for FLS: A Survey of Residents in Obstetrics and Gynecology Porter AE,1,* Chang S,2 Fuller T,3 Kho KA4. 1Obstetrics & Gynecology, UT Southwestern, Dallas, TX; 2UT Southwestern, Dallas; 3UT Southwestern, Dallas, TX; 4Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX *Corresponding author. Study Objective: Fundamentals of Laparoscopic Surgery (FLS) is a validated curriculum that uses laparoscopic simulation to prepare surgeons for the operating room. The American Board of Obstetrics and Gynecology has made FLS certification an eligibility requirement to take the certifying board exam for residents graduating in 2020 and onwards. The objective of this study is to describe the resident experience and to quantify test preparation for the FLS exam. Design: This is a prospective observational study at a large academic medical center. Setting: This study took place at UT Southwestern Medical Center between September 1, 2018 and March 31, 2019. Patients or Participants: Second year residents in Obstetrics and Gynecology were invited to participate in the study if they had completed their initial FLS certification exam. Of 18 second year residents, 15 met eligibility criteria and all agreed to participate. Interventions: Participants completed a two-page questionnaire about their preparation for the exam, including questions about practice time and repetitions for the five skills tasks and time spent watching the FLS-provided videos. Measurements and Main Results: 15 residents completed the survey. Participants spent an average of 3 sessions practicing for an average of 23 hours per task. 11/15 residents rated the ligating loop the easiest task to master and 8/15 residents rated the precision cut most difficult. Residents viewed the training modules an average of 1.7 times. All 15 residents who took the exam passed. Conclusion: FLS certification will soon be a requirement of all graduating US residents in Obstetrics & Gynecology. Residents and training programs will benefit from an understanding of the time and resources required to successfully take this exam. Our data suggests that residents spent upwards of 10 hours practicing to proficiency on the simulation tasks, in addition to viewing the training videos. Virtual Poster Session 2: Basic Science/Research/Education (1:30 PM − 1:40 PM) 1:30 PM: STATION N 3028 Peer-Coaching Effect On Laparoscopic Surgical Skills Amongst OB/GYN Residents. A Quality Improvement Randomized Controlled Study