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1426 Gynecologic Surgeons’ Perspectives of Same-Day Discharge (SDD) after Minimally Invasive Hysterectomy and Sacrocolpopexy
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
tissue was seen on ultrasound scan. The patient underwent hysteroscopic resection of retained pregnancy tissue using hysteroscopic forceps. Histology confirmed residual trophoblasts and subsequent to the procedure her symptoms resolved. Case 2) 27 year old Para 1 (two previous caesarean section) presented at 6 weeks gestation with a suspected caesarean scar ectopic pregnancy. Primary surgical management of miscarriage was performed under ultrasound guidance with minimal blood loss. However patient subsequently presented with irregular heavy vaginal bleeding and persistent spasmodic suprapubic pain. Ultrasound showed retained trophoblastic tissue within the caesarean scar niche. Laparoscopic excision of caesarean scar niche and repair was performed. Subsequent to the procedure her symptoms resolved and this patient has had a further successful pregnancy. Conclusion: The optimal management for caesarean scar ectopic pregnancies have yet to be established although recent evidence are supportive of primary surgical management by suction evacuation. Retained products of conception after surgical evacuation Caesarean scar ectopic pregnancies can be associated with intermittent heavy vaginal bleeding and intermenstrual bleeding. In cases where conservative management fails retained trophoblastic tissue may be excised via the hysteroscopic or laparoscopic route. Both routes for management have associated advantages and risks and decision for management should be personalised depending on size, location and accessibility of retained tissue.
minimally invasive hysterectomy and/or sacrocolpopexy is both safe and feasible - many still routinely admit patients overnight and few discharge patients the same day after minimally invasive sacrocolpopexy. Years from completion of training was associated with likelihood of SDD.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION B 1426 Gynecologic Surgeons’ Perspectives of Same-Day Discharge (SDD) after Minimally Invasive Hysterectomy and Sacrocolpopexy Yoder C,1,* Evans S,2 Brown J,3 Vilasagar S4. 1OBGYN, Atrium Health, Charlotte, NC; 2Atrium Health, Charlotte, NC; 3Levine Cancer Institute, Atrium Health, Charlotte, NC; 4Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Atrium Health, Charlotte, NC *Corresponding author. Study Objective: To describe gynecologic surgeons’ experience with, and opinions regarding, SDD after minimally invasive hysterectomy and sacrocolpopexy. Design: Cross-sectional survey study. Setting: Online questionnaire distributed March 2019 Patients or Participants: Two hundred and ninety-six of 7,112 (4.16%) physician-members of AAGL completed this study. Interventions: Original questionnaire, beta tested for content validity among experts. Measurements and Main Results: Approximately half (47.2%) of respondents reported discharging >75% of patients the same day after minimally invasive hysterectomy, while 25% never discharge the same day. Most (57.8%) reported never discharging patients the same day after minimally invasive sacrocolpopexy, while 25.2% reported discharging >75% the same day. Providers in the US and Canada were more likely to discharge patients the same day as hysterectomy compared to other regions of the world (p<0.01). Most surgeons felt that SDD after minimally invasive hysterectomy and/or sacrocolpopexy improves patient satisfaction (64.5%) and that SDD is both safe (89% and 69.8%) and feasible (93.2% and 76.0%) without increasing complications (85.6% and 77%) after these procedures respectively. Current trainees and surgeons 0-5 years from training were more likely to report SDD is safe after hysterectomy (98% v. 85%, p<0.01) and sacrocolpopexy (92% v. 77%, p=0.02). Providers felt SDD was safe regardless of laparoscopic versus robotic approach (p=0.32). The most commonly reported reasons for not discharging patients the same day included: procedure completed late in the day (57.0%) and patient expectation to stay overnight (52.2%). Conclusion: While most gynecologic surgeons discharge patients the same day as minimally invasive hysterectomy - and feel that SDD after
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION C 1478 Retrospective Comparisson In Single Port Total Laparoscopic Hysterectomy Between Conventional Intracorporeal Barbed Suture and Vaginal Approach Barbed Suture Mun ST,1,* Chung SH2. 1Dept of OBGY, Soonchunhyang University cheonan Hospital, cheonan, Korea, Republic of (South); 2Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea, Republic of (South) *Corresponding author. Study Objective: To compare the efficacy and safety between two methods such as conventional intracorporeal Barbed suture and vaginal approached Barbed suture in single port TLH. Design: Retrospective analysis of 194 consecutive cases of single port TLH. Setting: Single surgeon in University Hospital. Patients or Participants: 194 women (ages 33-53 yrs) undergoing single port Total Laparoscopic hysterectomy. 99 women were conventional intracorporeal Barbed suture group, 96 women were vaginal approached Barbed suture group. Interventions: Charts were reviewed to determine post-operative complications and surgical values. A comparison was made between two groups in post-operative hemoglobin, and hematocrits changes, operation time, blood loss during operation, post-operative drainage volume.(n=194) Measurements and Main Results: There were no statistically significant difference between two groups in terms of age, indication for surgery, uterine size, body mass index, parity. There were no significant difference in the average time of the procedure between two groups(conventional intracorporeal Barbed suture vs vaginal approached Barbed suture), 45.0 min vs 44.1 min(p<0.05). There were no significant differences in blood loss, 119.3ml vs 123.1ml(p<0.05), change in hemoglobin, 1.31 vs 1.29(p<0.05) and hematocrit, 8.45 vs 8.32(p<0.05). Conclusion: Two methods of conventional intracorporeal Barbed suture and vaginal approached Barbed suture in single port TLH were feasible and safe. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION D 2131 Trends in Patient Follow-Up after Minimally Invasive Hysterectomy Smith KA,* Frazzini Padilla P.M., Sprague ML. Gynecology, Cleveland Clinic Florida, Weston, FL *Corresponding author. Study Objective: To determine practice trends for evaluating patients following minimally invasive hysterectomy among gynecologic surgeons. Design: Anonymous voluntary survey was distributed to members of the American Association of Gynecologic Laparoscopists. The survey collected information on surgeon demographics and practice patterns for postoperative care following minimally invasive hysterectomy. Setting: E-mail based survey. Patients or Participants: Gynecologic surgeons who self-identified as performing minimally invasive hysterectomy via vaginal, laparoscopic, or robotic-assisted technique.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
tissue was seen on ultrasound scan. The patient underwent hysteroscopic resection of retained pregnancy tissue using hysteroscopic forceps. Histology confirmed residual trophoblasts and subsequent to the procedure her symptoms resolved. Case 2) 27 year old Para 1 (two previous caesarean section) presented at 6 weeks gestation with a suspected caesarean scar ectopic pregnancy. Primary surgical management of miscarriage was performed under ultrasound guidance with minimal blood loss. However patient subsequently presented with irregular heavy vaginal bleeding and persistent spasmodic suprapubic pain. Ultrasound showed retained trophoblastic tissue within the caesarean scar niche. Laparoscopic excision of caesarean scar niche and repair was performed. Subsequent to the procedure her symptoms resolved and this patient has had a further successful pregnancy. Conclusion: The optimal management for caesarean scar ectopic pregnancies have yet to be established although recent evidence are supportive of primary surgical management by suction evacuation. Retained products of conception after surgical evacuation Caesarean scar ectopic pregnancies can be associated with intermittent heavy vaginal bleeding and intermenstrual bleeding. In cases where conservative management fails retained trophoblastic tissue may be excised via the hysteroscopic or laparoscopic route. Both routes for management have associated advantages and risks and decision for management should be personalised depending on size, location and accessibility of retained tissue.
minimally invasive hysterectomy and/or sacrocolpopexy is both safe and feasible - many still routinely admit patients overnight and few discharge patients the same day after minimally invasive sacrocolpopexy. Years from completion of training was associated with likelihood of SDD.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION B 1426 Gynecologic Surgeons’ Perspectives of Same-Day Discharge (SDD) after Minimally Invasive Hysterectomy and Sacrocolpopexy Yoder C,1,* Evans S,2 Brown J,3 Vilasagar S4. 1OBGYN, Atrium Health, Charlotte, NC; 2Atrium Health, Charlotte, NC; 3Levine Cancer Institute, Atrium Health, Charlotte, NC; 4Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Atrium Health, Charlotte, NC *Corresponding author. Study Objective: To describe gynecologic surgeons’ experience with, and opinions regarding, SDD after minimally invasive hysterectomy and sacrocolpopexy. Design: Cross-sectional survey study. Setting: Online questionnaire distributed March 2019 Patients or Participants: Two hundred and ninety-six of 7,112 (4.16%) physician-members of AAGL completed this study. Interventions: Original questionnaire, beta tested for content validity among experts. Measurements and Main Results: Approximately half (47.2%) of respondents reported discharging >75% of patients the same day after minimally invasive hysterectomy, while 25% never discharge the same day. Most (57.8%) reported never discharging patients the same day after minimally invasive sacrocolpopexy, while 25.2% reported discharging >75% the same day. Providers in the US and Canada were more likely to discharge patients the same day as hysterectomy compared to other regions of the world (p<0.01). Most surgeons felt that SDD after minimally invasive hysterectomy and/or sacrocolpopexy improves patient satisfaction (64.5%) and that SDD is both safe (89% and 69.8%) and feasible (93.2% and 76.0%) without increasing complications (85.6% and 77%) after these procedures respectively. Current trainees and surgeons 0-5 years from training were more likely to report SDD is safe after hysterectomy (98% v. 85%, p<0.01) and sacrocolpopexy (92% v. 77%, p=0.02). Providers felt SDD was safe regardless of laparoscopic versus robotic approach (p=0.32). The most commonly reported reasons for not discharging patients the same day included: procedure completed late in the day (57.0%) and patient expectation to stay overnight (52.2%). Conclusion: While most gynecologic surgeons discharge patients the same day as minimally invasive hysterectomy - and feel that SDD after
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION C 1478 Retrospective Comparisson In Single Port Total Laparoscopic Hysterectomy Between Conventional Intracorporeal Barbed Suture and Vaginal Approach Barbed Suture Mun ST,1,* Chung SH2. 1Dept of OBGY, Soonchunhyang University cheonan Hospital, cheonan, Korea, Republic of (South); 2Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea, Republic of (South) *Corresponding author. Study Objective: To compare the efficacy and safety between two methods such as conventional intracorporeal Barbed suture and vaginal approached Barbed suture in single port TLH. Design: Retrospective analysis of 194 consecutive cases of single port TLH. Setting: Single surgeon in University Hospital. Patients or Participants: 194 women (ages 33-53 yrs) undergoing single port Total Laparoscopic hysterectomy. 99 women were conventional intracorporeal Barbed suture group, 96 women were vaginal approached Barbed suture group. Interventions: Charts were reviewed to determine post-operative complications and surgical values. A comparison was made between two groups in post-operative hemoglobin, and hematocrits changes, operation time, blood loss during operation, post-operative drainage volume.(n=194) Measurements and Main Results: There were no statistically significant difference between two groups in terms of age, indication for surgery, uterine size, body mass index, parity. There were no significant difference in the average time of the procedure between two groups(conventional intracorporeal Barbed suture vs vaginal approached Barbed suture), 45.0 min vs 44.1 min(p<0.05). There were no significant differences in blood loss, 119.3ml vs 123.1ml(p<0.05), change in hemoglobin, 1.31 vs 1.29(p<0.05) and hematocrit, 8.45 vs 8.32(p<0.05). Conclusion: Two methods of conventional intracorporeal Barbed suture and vaginal approached Barbed suture in single port TLH were feasible and safe. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION D 2131 Trends in Patient Follow-Up after Minimally Invasive Hysterectomy Smith KA,* Frazzini Padilla P.M., Sprague ML. Gynecology, Cleveland Clinic Florida, Weston, FL *Corresponding author. Study Objective: To determine practice trends for evaluating patients following minimally invasive hysterectomy among gynecologic surgeons. Design: Anonymous voluntary survey was distributed to members of the American Association of Gynecologic Laparoscopists. The survey collected information on surgeon demographics and practice patterns for postoperative care following minimally invasive hysterectomy. Setting: E-mail based survey. Patients or Participants: Gynecologic surgeons who self-identified as performing minimally invasive hysterectomy via vaginal, laparoscopic, or robotic-assisted technique.