- Email: [email protected]
1420 A Bibliometric Review of the Top Cited Articles in The History of the Journal of Minimally Invasive Gynecology
S160
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
supplemented with 10 ng/mL basic fibroblast growth factor, 20 ng/mL epidermal growth factor and plated in an ultra-low attachment plate to prevent adherence. Spheres were counted at 14 days after plating. All experiments were performed in triplicate. Measurements and Main Results: Firstly, we discovered that miR-424 and miR-503 are lowly expressed in ovarian cancer stem-like cells (CSCs) compared with non-CSCs. Over-expression of miR-424 and miR-503 resulted in decreased cancer colony formation, migration in ovarian cancer cell lines. Moreover, miR-424 and miR-503 overexpression caused inhibition of spheroid formation and the DNA damage repair pathway, while over-expression of Wee1 caused increased spheroid formation and cell survival in ovarian CSCs. Secondly, we found that the stem cell marker NANOG decreased miR-424 and miR503 transcription in ovarian CSCs. In addition, miR-424 and miR-503 bind to the 3’ UTR of WEE1 to decrease its expression. Finally, we found that atorvastatin treatment increased miR-424 and miR-503 expression while it significantly decreased NANOG and WEE1 expression in ovarian CSCs. Conclusion: Our findings indicate that increased WEE1 is an oncogenic marker for ovarian CSCs and is a potential target for CSC-specific therapy.
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM)
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION D 2958 Robotic Ureteral Reimplantation for Posthysterectomy Injury: Is Laparotomy Necessary Salom EM,1,* Sowby TC2. 1Division of Gynecologic Oncology, Florida International University, Miami, FL; 2Department o Obstetrics and Gynecology, Community of Health Institute, Miami, FL *Corresponding author. Study Objective: There is limited data on robotic ureteral reimplantation for ureteral injury following hysterectomy. The aim of this study is to demonstrate the use of robotic ureteral reimplantation in a setting of ureteral injury sustained during hysterectomy. Design: Retrospective case series Setting: Hospital Patients or Participants: Patients who developed ureteral obstruction as a result of hysterectomy Interventions: Robotic ureteral implantation Measurements and Main Results: This case series exhibited a 100% rate of success of robotic ureteral reimplantation without conversion from robotic to an open procedure. Two patients presented with injury in bilateral ureters (unilateral ureteral reimplantation with contralateral stenting), 4 with injury on the left, and 3 with injury on the right, 1 bilateral. 2 of the 8 procedures had a history of concurrent bladder injury during the initial surgery. The mean days to the recognition of ureteral injury was 6.5 days. 37.5% underwent concomitant lysis of adhesions during the robotic ureteroneocystostomy. The Jackson-Pratt drain, ureteral stents, and foley catheters remained upon discharge and were removed in the office postoperatively. JP drains were removed on ave 8.5 (8-10) days. Foley catheters were removed on 10.8 average (6-18) days. Ureteral stents were removed mean 34 (28-47) days. All patient underwent serial outpatient Renal US post-operatively with only 25% of patients exhibiting mild hydronephrosis following ureteral reimplantation and ureteral stent removal. 0% of patient required surgical revision of the ureteroneocystostomy. Mean duration of post-operative follow up was 110.75 (22-270) days. Conclusion: The use of robotic ureteral reimplantation is effective and safe and is underutilized. This case series demonstrates effective utilization of robotics in ureteroneocystostomy following ureteral injury sustained during hysterectomy without the need of surgical revision of the ureteroneocystostomy post-operatively, no loss of renal units, and no significant hydronephrosis.
1:40 PM: STATION E 1554 OB/GYN Resident Interest And Exposure To NonClinical Healthcare Industry Careers: A Survey-Based Study Of Large Academic Institutions Webster EM,* Simoni M, Fan LL, Desai V, Cron J. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT *Corresponding author. Study Objective: Much of healthcare innovation and advancement of patient care stems from non-clinical settings within the healthcare industry. This study aimed to evaluate OB/GYN resident exposure, knowledge, and attitude towards the relationship between the healthcare industry and medicine. Design: An electronic, survey-based, cross-sectional study. Setting: N/A Patients or Participants: A Qualtrics survey was emailed to program directors and coordinators of ACGME-accredited OB/GYN residency programs with a request to forward the survey to their resident body. Only the responses of residents self-identifying as being from “large academic hospitals” were included in this study. Interventions: OB/GYN residents were requested to complete an anonymous 22-question survey. The survey collected demographic information and assessed exposure to and interest in non-clinical healthcare careers (examples include medical device development, healthcare consulting, and hospital administration). Questions were adapted from validated sources or designed through an iterative peer-review process. Statistics were performed using STATA. Measurements and Main Results: The survey was started 105 times and completed 94 times (89%). Twenty-two percent (n=21) of respondents held a dual degree; 21% (n=20) previously held non-clinical jobs in healthcare industry. Roughly a third (37%, n=35) reported interacting with degreed industry professionals only once per year. Only 8% (n=8) felt they had sufficient knowledge of industry careers, while 84% (n=79) were interested in learning more about how the healthcare system interacts with business and research. Nearly half (48%, n=46) were interested in a healthcare industry elective during residency. About one fourth (26%, n=25) expressed interest in pursuing non-clinical careers. Conclusion: OB/GYN residents from large academic institutions have interest in non-clinical healthcare industry careers and desire exposure to such careers during residency. These findings indicate a need for a more thoughtful and collaborative approach between clinical medicine and the healthcare industry, while maintaining unbiased education.
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION F 1420 A Bibliometric Review of the Top Cited Articles in The History of the Journal of Minimally Invasive Gynecology Hadaya O,* Balica AC. Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ *Corresponding author. Study Objective: Bibliometric analysis can identify impactful articles in a specialty’s history as well as highlight areas upon which future research can expand. It has thus garnered interest across multiple specialties. Our purpose was to identify and characterize the most highly cited articles in the history of The Journal of Minimally Invasive Gynecology (JMIG).
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S161
Design: We used the ISI Web of Science database to identify the most frequently cited articles published in JMIG between the years of 2005, when it was first published, to 2018. The top 100 most frequently cited articles were included in our analysis. The articles were then characterized by publication year, study design, specialty, country of origin, and topic. The topics were subdivided into the following categories: surgical techniques, education, urogynecology, endometriosis, reproductive surgery, abnormal uterine bleeding, leiomyomata, oncology, sterilization, and, surgical complications. Setting: N/a Patients or Participants: N/a Interventions: N/a Measurements and Main Results: A total of 2,727 articles were published by JMIG in this time frame. Of the top 100 articles, 47% were observational studies, 11% were new procedures/assays, and 11% were randomized control trials. 57% were from international authors. The most frequently cited topic was surgical techniques (30%), followed by surgical complications (17%) and endometriosis (11%). The mean citation number was 68.94. The median publication year of the top 100 articles was 2008. After 2008, the number of articles on surgical technique decreased (37% vs 26%) whereas the prevalence of those focusing on surgical complications increased (13% to 22%). Conclusion: The majority of publications were observational studies, with a strong focus on surgical techniques. The number of articles on this topic decreased slightly after 2008, which also saw an increased focus on surgical complications. This data reiterates the leading role and global impact of JMIG in gynecological surgery.
86.8% noted >20% reduction. Significant mean improvements at 12 months were realized in both symptom severity and health-related quality of life (33.8 points and 45.8 points, respectively). Mean maximal fibroid volume reduction per patient was 63.8%. There were no device related adverse events. Mean length of stay was 2.5 hours and 50% of patients returned to normal activity within 1 day. Conclusion: This analysis of US patients in the SONATA pivotal IDE trial demonstrates results consistent with those in the full cohort. Treatment with the Sonata system significantly reduced fibroid symptoms with a low surgical reintervention rate through 12 months. These results support the efficacy and safety of Sonata as a first-line treatment for women affected by symptomatic uterine fibroids.
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION G 1630 12-Month Outcomes of the Us Patient Cohort in the Sonata Pivotal IDE Trial of Transcervical Ablation of Uterine Fibroids Hudgens JL,1,* Johns DA,2 Lukes A,3 Forstein DA,4 Delvadia D5. 1 Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 2Gynecology, Baylor Research Institute-Fort Worth, Fort Worth, TX; 3 Carolina Women’s Research and Wellness Center, Durham, NC; 4Touro College of Osteopathic Medicine, New York, NY; 5Drexel University College of Medicine, Philadelphia, PA *Corresponding author. Study Objective: The SONATA trial was performed in the United States (US) and Mexico to examine the safety and effectiveness of transcervical radiofrequency ablation in the treatment of symptomatic uterine fibroids. This is an analysis of 12-month clinical outcomes in the US cohort. Design: Prospective, longitudinal, multicenter, single-arm trial. Setting: 21 clinical sites in the US. Patients or Participants: Premenopausal women between the ages of 25 and 50 with heavy menstrual bleeding secondary to fibroids. Interventions: Transcervical, intrauterine radiofrequency ablation was performed on ≤10 uterine fibroids from 1 to 5 cm in diameter with the SonataÒ system. Twelve-month co-primary endpoints were reduction in menstrual bleeding and rate of surgical reintervention. Symptom severity, quality of life, satisfaction, safety, and fibroid volume reduction were also evaluated. Measurements and Main Results: 125 patients were enrolled/treated in the US. Both IDE trial co-primary endpoints were achieved, as 65.3% of patients reported ≥50% reduction in menstrual bleeding and 99.2% of patients were free from surgical reintervention. Symptom improvement was noted by 97.4% of patients and 98.3% were satisfied. Ninety-five percent of patients reported reduced menstrual bleeding at 12 months, and
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION H 2782 The Impact of a Simulation Curriculum Designed for Instituting Gynecologic Laparoscopy in Low and Middle Income Settings Harvey LFB,1 Mata AJ,2,* Curlin HL,3 Grimm BS,2 Lovett BJ,2 Sizemore CM,2 Ulysse JC4. 1Minimally Invasive Gynecology, Vanderbilt University Medical Center, Nashville, TN; 2Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; 3Vanderbilt University Medical Center, Nashville, TN; 4Obstetrics and Gynecology, H^ opital Universitaire de Mirebalais, Mirebalais, Haiti *Corresponding author. Study Objective: To measure the effect of a simulation curriculum designed for instituting gynecologic laparoscopy in low and middleincome settings on competent gynecologic surgeons with novice laparoscopic skills Design: Prospective, single center, implementation study Setting: H^opital Universitaire de Mirebalais in Haiti (HUM), a 300-bed hospital operating with the Haitian Ministry of Health and Partners in Health, a Boston-based non-profit organization. Patients or Participants: Four recent OB/GYN residency graduates and three attending OB/GYN physicians at HUM. The physicians had minimal experience with laparoscopy but were skilled abdomino-pelvic surgeons. Interventions: A 5-day gynecologic laparoscopy curriculum was instituted. Trainees participated in increasingly complex simulations interspersed with didactic learning. Simulations included assembling and operating laparoscopic equipment, completing a laparoscopy specific surgical checklist, positioning patients, placing trocars, operating on a box trainer, and troubleshooting surgical complications and equipment malfunctions. Finally, participants completed bilateral salpingectomies on selected patients at HUM with at-the-elbow instructors. The trainees underwent pre- and post-training tests with simulation box training on 3 laparoscopic skills tasks; peg transfer, rubber band manipulation, and circle cut. Measurements and Main Results: There were no operative complications. Two evaluators independently scored de-identified pre- and post-test videos of box trainer tasks using a modified OSATS scale (Objective Structured Assessments of Technical Skills). Both were fellowship trained gynecologic surgeons who regularly teach laparoscopy. The mean increase in OSATS scores after training was 4.3 out of 25 possible points (SD 2.7, R 0-8). A Wilcoxon signed rank test of equality of matched pairs was significant. (Prob > jzj = 0.0001.) Conclusion: An intensive, short-term curriculum designed for instituting gynecologic laparoscopy in low and middle-income settings significantly increased the measurable laparoscopic skill of 7 gynecologic surgeons who were novices to laparoscopy. Further implementation science regarding the development of gynecologic laparoscopy in low and middleincome settings is needed.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
supplemented with 10 ng/mL basic fibroblast growth factor, 20 ng/mL epidermal growth factor and plated in an ultra-low attachment plate to prevent adherence. Spheres were counted at 14 days after plating. All experiments were performed in triplicate. Measurements and Main Results: Firstly, we discovered that miR-424 and miR-503 are lowly expressed in ovarian cancer stem-like cells (CSCs) compared with non-CSCs. Over-expression of miR-424 and miR-503 resulted in decreased cancer colony formation, migration in ovarian cancer cell lines. Moreover, miR-424 and miR-503 overexpression caused inhibition of spheroid formation and the DNA damage repair pathway, while over-expression of Wee1 caused increased spheroid formation and cell survival in ovarian CSCs. Secondly, we found that the stem cell marker NANOG decreased miR-424 and miR503 transcription in ovarian CSCs. In addition, miR-424 and miR-503 bind to the 3’ UTR of WEE1 to decrease its expression. Finally, we found that atorvastatin treatment increased miR-424 and miR-503 expression while it significantly decreased NANOG and WEE1 expression in ovarian CSCs. Conclusion: Our findings indicate that increased WEE1 is an oncogenic marker for ovarian CSCs and is a potential target for CSC-specific therapy.
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM)
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION D 2958 Robotic Ureteral Reimplantation for Posthysterectomy Injury: Is Laparotomy Necessary Salom EM,1,* Sowby TC2. 1Division of Gynecologic Oncology, Florida International University, Miami, FL; 2Department o Obstetrics and Gynecology, Community of Health Institute, Miami, FL *Corresponding author. Study Objective: There is limited data on robotic ureteral reimplantation for ureteral injury following hysterectomy. The aim of this study is to demonstrate the use of robotic ureteral reimplantation in a setting of ureteral injury sustained during hysterectomy. Design: Retrospective case series Setting: Hospital Patients or Participants: Patients who developed ureteral obstruction as a result of hysterectomy Interventions: Robotic ureteral implantation Measurements and Main Results: This case series exhibited a 100% rate of success of robotic ureteral reimplantation without conversion from robotic to an open procedure. Two patients presented with injury in bilateral ureters (unilateral ureteral reimplantation with contralateral stenting), 4 with injury on the left, and 3 with injury on the right, 1 bilateral. 2 of the 8 procedures had a history of concurrent bladder injury during the initial surgery. The mean days to the recognition of ureteral injury was 6.5 days. 37.5% underwent concomitant lysis of adhesions during the robotic ureteroneocystostomy. The Jackson-Pratt drain, ureteral stents, and foley catheters remained upon discharge and were removed in the office postoperatively. JP drains were removed on ave 8.5 (8-10) days. Foley catheters were removed on 10.8 average (6-18) days. Ureteral stents were removed mean 34 (28-47) days. All patient underwent serial outpatient Renal US post-operatively with only 25% of patients exhibiting mild hydronephrosis following ureteral reimplantation and ureteral stent removal. 0% of patient required surgical revision of the ureteroneocystostomy. Mean duration of post-operative follow up was 110.75 (22-270) days. Conclusion: The use of robotic ureteral reimplantation is effective and safe and is underutilized. This case series demonstrates effective utilization of robotics in ureteroneocystostomy following ureteral injury sustained during hysterectomy without the need of surgical revision of the ureteroneocystostomy post-operatively, no loss of renal units, and no significant hydronephrosis.
1:40 PM: STATION E 1554 OB/GYN Resident Interest And Exposure To NonClinical Healthcare Industry Careers: A Survey-Based Study Of Large Academic Institutions Webster EM,* Simoni M, Fan LL, Desai V, Cron J. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT *Corresponding author. Study Objective: Much of healthcare innovation and advancement of patient care stems from non-clinical settings within the healthcare industry. This study aimed to evaluate OB/GYN resident exposure, knowledge, and attitude towards the relationship between the healthcare industry and medicine. Design: An electronic, survey-based, cross-sectional study. Setting: N/A Patients or Participants: A Qualtrics survey was emailed to program directors and coordinators of ACGME-accredited OB/GYN residency programs with a request to forward the survey to their resident body. Only the responses of residents self-identifying as being from “large academic hospitals” were included in this study. Interventions: OB/GYN residents were requested to complete an anonymous 22-question survey. The survey collected demographic information and assessed exposure to and interest in non-clinical healthcare careers (examples include medical device development, healthcare consulting, and hospital administration). Questions were adapted from validated sources or designed through an iterative peer-review process. Statistics were performed using STATA. Measurements and Main Results: The survey was started 105 times and completed 94 times (89%). Twenty-two percent (n=21) of respondents held a dual degree; 21% (n=20) previously held non-clinical jobs in healthcare industry. Roughly a third (37%, n=35) reported interacting with degreed industry professionals only once per year. Only 8% (n=8) felt they had sufficient knowledge of industry careers, while 84% (n=79) were interested in learning more about how the healthcare system interacts with business and research. Nearly half (48%, n=46) were interested in a healthcare industry elective during residency. About one fourth (26%, n=25) expressed interest in pursuing non-clinical careers. Conclusion: OB/GYN residents from large academic institutions have interest in non-clinical healthcare industry careers and desire exposure to such careers during residency. These findings indicate a need for a more thoughtful and collaborative approach between clinical medicine and the healthcare industry, while maintaining unbiased education.
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION F 1420 A Bibliometric Review of the Top Cited Articles in The History of the Journal of Minimally Invasive Gynecology Hadaya O,* Balica AC. Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ *Corresponding author. Study Objective: Bibliometric analysis can identify impactful articles in a specialty’s history as well as highlight areas upon which future research can expand. It has thus garnered interest across multiple specialties. Our purpose was to identify and characterize the most highly cited articles in the history of The Journal of Minimally Invasive Gynecology (JMIG).
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S161
Design: We used the ISI Web of Science database to identify the most frequently cited articles published in JMIG between the years of 2005, when it was first published, to 2018. The top 100 most frequently cited articles were included in our analysis. The articles were then characterized by publication year, study design, specialty, country of origin, and topic. The topics were subdivided into the following categories: surgical techniques, education, urogynecology, endometriosis, reproductive surgery, abnormal uterine bleeding, leiomyomata, oncology, sterilization, and, surgical complications. Setting: N/a Patients or Participants: N/a Interventions: N/a Measurements and Main Results: A total of 2,727 articles were published by JMIG in this time frame. Of the top 100 articles, 47% were observational studies, 11% were new procedures/assays, and 11% were randomized control trials. 57% were from international authors. The most frequently cited topic was surgical techniques (30%), followed by surgical complications (17%) and endometriosis (11%). The mean citation number was 68.94. The median publication year of the top 100 articles was 2008. After 2008, the number of articles on surgical technique decreased (37% vs 26%) whereas the prevalence of those focusing on surgical complications increased (13% to 22%). Conclusion: The majority of publications were observational studies, with a strong focus on surgical techniques. The number of articles on this topic decreased slightly after 2008, which also saw an increased focus on surgical complications. This data reiterates the leading role and global impact of JMIG in gynecological surgery.
86.8% noted >20% reduction. Significant mean improvements at 12 months were realized in both symptom severity and health-related quality of life (33.8 points and 45.8 points, respectively). Mean maximal fibroid volume reduction per patient was 63.8%. There were no device related adverse events. Mean length of stay was 2.5 hours and 50% of patients returned to normal activity within 1 day. Conclusion: This analysis of US patients in the SONATA pivotal IDE trial demonstrates results consistent with those in the full cohort. Treatment with the Sonata system significantly reduced fibroid symptoms with a low surgical reintervention rate through 12 months. These results support the efficacy and safety of Sonata as a first-line treatment for women affected by symptomatic uterine fibroids.
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION G 1630 12-Month Outcomes of the Us Patient Cohort in the Sonata Pivotal IDE Trial of Transcervical Ablation of Uterine Fibroids Hudgens JL,1,* Johns DA,2 Lukes A,3 Forstein DA,4 Delvadia D5. 1 Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 2Gynecology, Baylor Research Institute-Fort Worth, Fort Worth, TX; 3 Carolina Women’s Research and Wellness Center, Durham, NC; 4Touro College of Osteopathic Medicine, New York, NY; 5Drexel University College of Medicine, Philadelphia, PA *Corresponding author. Study Objective: The SONATA trial was performed in the United States (US) and Mexico to examine the safety and effectiveness of transcervical radiofrequency ablation in the treatment of symptomatic uterine fibroids. This is an analysis of 12-month clinical outcomes in the US cohort. Design: Prospective, longitudinal, multicenter, single-arm trial. Setting: 21 clinical sites in the US. Patients or Participants: Premenopausal women between the ages of 25 and 50 with heavy menstrual bleeding secondary to fibroids. Interventions: Transcervical, intrauterine radiofrequency ablation was performed on ≤10 uterine fibroids from 1 to 5 cm in diameter with the SonataÒ system. Twelve-month co-primary endpoints were reduction in menstrual bleeding and rate of surgical reintervention. Symptom severity, quality of life, satisfaction, safety, and fibroid volume reduction were also evaluated. Measurements and Main Results: 125 patients were enrolled/treated in the US. Both IDE trial co-primary endpoints were achieved, as 65.3% of patients reported ≥50% reduction in menstrual bleeding and 99.2% of patients were free from surgical reintervention. Symptom improvement was noted by 97.4% of patients and 98.3% were satisfied. Ninety-five percent of patients reported reduced menstrual bleeding at 12 months, and
Virtual Poster Session 2: Basic Science/Research/Education (1:40 PM − 1:50 PM) 1:40 PM: STATION H 2782 The Impact of a Simulation Curriculum Designed for Instituting Gynecologic Laparoscopy in Low and Middle Income Settings Harvey LFB,1 Mata AJ,2,* Curlin HL,3 Grimm BS,2 Lovett BJ,2 Sizemore CM,2 Ulysse JC4. 1Minimally Invasive Gynecology, Vanderbilt University Medical Center, Nashville, TN; 2Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; 3Vanderbilt University Medical Center, Nashville, TN; 4Obstetrics and Gynecology, H^ opital Universitaire de Mirebalais, Mirebalais, Haiti *Corresponding author. Study Objective: To measure the effect of a simulation curriculum designed for instituting gynecologic laparoscopy in low and middleincome settings on competent gynecologic surgeons with novice laparoscopic skills Design: Prospective, single center, implementation study Setting: H^opital Universitaire de Mirebalais in Haiti (HUM), a 300-bed hospital operating with the Haitian Ministry of Health and Partners in Health, a Boston-based non-profit organization. Patients or Participants: Four recent OB/GYN residency graduates and three attending OB/GYN physicians at HUM. The physicians had minimal experience with laparoscopy but were skilled abdomino-pelvic surgeons. Interventions: A 5-day gynecologic laparoscopy curriculum was instituted. Trainees participated in increasingly complex simulations interspersed with didactic learning. Simulations included assembling and operating laparoscopic equipment, completing a laparoscopy specific surgical checklist, positioning patients, placing trocars, operating on a box trainer, and troubleshooting surgical complications and equipment malfunctions. Finally, participants completed bilateral salpingectomies on selected patients at HUM with at-the-elbow instructors. The trainees underwent pre- and post-training tests with simulation box training on 3 laparoscopic skills tasks; peg transfer, rubber band manipulation, and circle cut. Measurements and Main Results: There were no operative complications. Two evaluators independently scored de-identified pre- and post-test videos of box trainer tasks using a modified OSATS scale (Objective Structured Assessments of Technical Skills). Both were fellowship trained gynecologic surgeons who regularly teach laparoscopy. The mean increase in OSATS scores after training was 4.3 out of 25 possible points (SD 2.7, R 0-8). A Wilcoxon signed rank test of equality of matched pairs was significant. (Prob > jzj = 0.0001.) Conclusion: An intensive, short-term curriculum designed for instituting gynecologic laparoscopy in low and middle-income settings significantly increased the measurable laparoscopic skill of 7 gynecologic surgeons who were novices to laparoscopy. Further implementation science regarding the development of gynecologic laparoscopy in low and middleincome settings is needed.