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2993 Trans Console Authority Gradient On Robotic Platform Dual Consoles in Resident Surgical Education
S222
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM)
Conclusion: The incidence of complications is similar to that reported in open surgery and discretely larger than laparoscopic, however type I complications were the most frequent. The high incidence of probably due to what we are is a school hospital and surgeons are training period.
1:20 PM: STATION T 2590 Robotic Block of Uterine Vessels in Different Anatomical Locations Wang HF,1,* Chuang YC2. 1Department of Gynecology & Obstetrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2OBS&GYN, Far Eastern Memorial Hospital, New Taipei City, Taiwan *Corresponding author. Video Objective: Robotic block and dissection of uterine vessels in three different anatomical locations. Setting: Since uterine arteries are responsible for 83% of blood flow supply to the uterine, we believe that control of uterine vessels is the most important step in the surgical procedures of hysterectomy, myomectomy or even uterus-sparing postpartum hemorrhage surgery. Interventions: Our clinical experience indicates that dissection and block uterine arteries by Da Vinci Robot are best conducted at three different anatomical locations: (1) The place where the uterine artery is divided from the internal iliac artery. (2) Where the uterine artery travels across the ureter (3) the site at which the uterine artery enters the cervix. Conclusion: Da Vinci robot advantageously provides 3D visualization and the rotatable endowrist, making the procedure of dissecting at different anatomical locations much easier and safer. Getting familiar with the anatomical sites can greatly help the aforementioned surgical procedures. Virtual Poster Session 4: Robotics (1:30 PM — 1:40 PM) 1:30 PM: STATION A 2990 Evaluation of the Incidence and Types of Complications in Patients Undergoing for Robot − Assisted Hysterectomy in a Third Level Care Hospital in Mexico Carmona MP,* Rivera M, Jimenez Cabrera DA. Advanced Robotic Surgery Center, Regional High Especialty Hospital, Zumpango, Zumpango, EM, Mexico *Corresponding author. Study Objective: To evaluate the incidence and types of complications in patients undergoing Robot-assisted hysterectomy. Design: Retrospective study. Setting: 3rd level care hospital in Zumpango, State of Mexico. Patients or Participants: Women undergoing robotic-assisted laparoscopic hysterectomy. Interventions: Robotic-assisted laparoscopic hysterectomy. Interventions: A total of 49 patients were included; the main indication for the procedure was uterine myomatosis in 75.5%, abnormal uterine bleeding refractory to treatment in 12.24% and in the rest, endometrial intraepithelial neoplasia, cervical cancer in situ among others. The incidence of complications was 20.40% (10 patients in total), some of them presenting up to two different complications. Complications were classified according to the scale of Claiven and Dindo, finding type I in 58% (most frequent seromas, lesion in the serosa of the sigmoid rectum and a perforation in the posterior cul-de-sac with uterine mobilizer). Type II in 8.3% (one patient with erosive gastritis requiring transfusion) and type III b in 33.3% with two conversions to open surgery (one for hemorrhage and one for non-recoverable equipment failure) and two re interventions (laparotomy due to hemoperitoneum and a laparoscopy for residual abscess drainage) no type IV or V lesions were found. Measurements and Main Results: The files of the patients undergoing robotic assisted laparoscopic hysterectomy from May 1, 2014 to April 30, 2019 were analyzed.
Virtual Poster Session 4: Robotics (1:30 PM — 1:40 PM) 1:30 PM: STATION B 2993 Trans Console Authority Gradient On Robotic Platform Dual Consoles in Resident Surgical Education Breen MT*. Women’s Health, UT Dell School of Medicine, Austin, TX *Corresponding author. Study Objective: To analyze and evaluate the role of dual console robotic technology in the surgical training environment of gynecologic surgical resident training. Modeled after aviation training dual controls with training pilots the trans cockpit authority gradient has been implicated in aviation accidents and " near misses". Extrapolating these phenomena to robotic training consoles and evaluating with Lickert scale analysis can assist with both learner and trainer surgical efficiency and safety. Design: Descriptive. Setting: Academic Multicenter Teaching Hospitals with Gynecology residents and general gynecology, FPMRS and gyn- oncology robotic faculty. Patients or Participants: PGY 2-4 Obstetrical and Gynecology residents in training. Interventions: Following systematic analysis of trans console authority gradient. Measurements and Main Results: Lickert analysis and OR observational analysis favors dual console for effective training, intraoperative surgical hand offs showed diminishment of negative perceptions across the console authority gradient. Conclusion: Affirmation of learner and instructor affinity for dual robotic consoles in training. Recognition that the trans console authority gradient can affect learner comfort and the learning environment. Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION C 2662 Accurate Dissection in Robotic Surgery Using the Double Bipolar Method-With Pinpoint Accuracy Andou M*. Obstetrics and Gynecology, Kurashiki Medical Center, Kurashiki, Japan *Corresponding author. Video Objective: To demonstrate the accuracy of dissection of the double bipolar method in robotic surgery. We will show operative techniques used in real surgical settings for procedures such as modified radical hysterectomy and retroperitoneal lymphadenectomy for clinical stage I endometrial cancer. Setting: Urban general hospital in Japan. Patients: From December 26, 2018 to April 22, 2019, 21 patients underwent these techniques. Interventions: We performed robotic modified radical hysterectomy and bilateral salpingo-oorphrectomy with pelvic lymphadenectomy robotically on a clinical stage Ia case (grade 1-2 histology). Some patients also underwent laparoscopic extraperitoneal paraaortic lymphadenectomy, and the case shown was clinical stage Ib (or grade 3 histology). This technique was pioneered by Prof Ichiro Uyama, a robotic gastrointestinal surgeon. We use robotic Maryland forceps as the cutting device with a Valleylab FT10 energy platform (ForceTriad energy platform) at macromode 60W. The advantage of this technique is that many of the concerns surrounding the use of other instrumentation such as monopolar scissors, where adjacent tissue may be inadvertently injured, are removed by the pinpoint
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM)
Conclusion: The incidence of complications is similar to that reported in open surgery and discretely larger than laparoscopic, however type I complications were the most frequent. The high incidence of probably due to what we are is a school hospital and surgeons are training period.
1:20 PM: STATION T 2590 Robotic Block of Uterine Vessels in Different Anatomical Locations Wang HF,1,* Chuang YC2. 1Department of Gynecology & Obstetrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2OBS&GYN, Far Eastern Memorial Hospital, New Taipei City, Taiwan *Corresponding author. Video Objective: Robotic block and dissection of uterine vessels in three different anatomical locations. Setting: Since uterine arteries are responsible for 83% of blood flow supply to the uterine, we believe that control of uterine vessels is the most important step in the surgical procedures of hysterectomy, myomectomy or even uterus-sparing postpartum hemorrhage surgery. Interventions: Our clinical experience indicates that dissection and block uterine arteries by Da Vinci Robot are best conducted at three different anatomical locations: (1) The place where the uterine artery is divided from the internal iliac artery. (2) Where the uterine artery travels across the ureter (3) the site at which the uterine artery enters the cervix. Conclusion: Da Vinci robot advantageously provides 3D visualization and the rotatable endowrist, making the procedure of dissecting at different anatomical locations much easier and safer. Getting familiar with the anatomical sites can greatly help the aforementioned surgical procedures. Virtual Poster Session 4: Robotics (1:30 PM — 1:40 PM) 1:30 PM: STATION A 2990 Evaluation of the Incidence and Types of Complications in Patients Undergoing for Robot − Assisted Hysterectomy in a Third Level Care Hospital in Mexico Carmona MP,* Rivera M, Jimenez Cabrera DA. Advanced Robotic Surgery Center, Regional High Especialty Hospital, Zumpango, Zumpango, EM, Mexico *Corresponding author. Study Objective: To evaluate the incidence and types of complications in patients undergoing Robot-assisted hysterectomy. Design: Retrospective study. Setting: 3rd level care hospital in Zumpango, State of Mexico. Patients or Participants: Women undergoing robotic-assisted laparoscopic hysterectomy. Interventions: Robotic-assisted laparoscopic hysterectomy. Interventions: A total of 49 patients were included; the main indication for the procedure was uterine myomatosis in 75.5%, abnormal uterine bleeding refractory to treatment in 12.24% and in the rest, endometrial intraepithelial neoplasia, cervical cancer in situ among others. The incidence of complications was 20.40% (10 patients in total), some of them presenting up to two different complications. Complications were classified according to the scale of Claiven and Dindo, finding type I in 58% (most frequent seromas, lesion in the serosa of the sigmoid rectum and a perforation in the posterior cul-de-sac with uterine mobilizer). Type II in 8.3% (one patient with erosive gastritis requiring transfusion) and type III b in 33.3% with two conversions to open surgery (one for hemorrhage and one for non-recoverable equipment failure) and two re interventions (laparotomy due to hemoperitoneum and a laparoscopy for residual abscess drainage) no type IV or V lesions were found. Measurements and Main Results: The files of the patients undergoing robotic assisted laparoscopic hysterectomy from May 1, 2014 to April 30, 2019 were analyzed.
Virtual Poster Session 4: Robotics (1:30 PM — 1:40 PM) 1:30 PM: STATION B 2993 Trans Console Authority Gradient On Robotic Platform Dual Consoles in Resident Surgical Education Breen MT*. Women’s Health, UT Dell School of Medicine, Austin, TX *Corresponding author. Study Objective: To analyze and evaluate the role of dual console robotic technology in the surgical training environment of gynecologic surgical resident training. Modeled after aviation training dual controls with training pilots the trans cockpit authority gradient has been implicated in aviation accidents and " near misses". Extrapolating these phenomena to robotic training consoles and evaluating with Lickert scale analysis can assist with both learner and trainer surgical efficiency and safety. Design: Descriptive. Setting: Academic Multicenter Teaching Hospitals with Gynecology residents and general gynecology, FPMRS and gyn- oncology robotic faculty. Patients or Participants: PGY 2-4 Obstetrical and Gynecology residents in training. Interventions: Following systematic analysis of trans console authority gradient. Measurements and Main Results: Lickert analysis and OR observational analysis favors dual console for effective training, intraoperative surgical hand offs showed diminishment of negative perceptions across the console authority gradient. Conclusion: Affirmation of learner and instructor affinity for dual robotic consoles in training. Recognition that the trans console authority gradient can affect learner comfort and the learning environment. Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION C 2662 Accurate Dissection in Robotic Surgery Using the Double Bipolar Method-With Pinpoint Accuracy Andou M*. Obstetrics and Gynecology, Kurashiki Medical Center, Kurashiki, Japan *Corresponding author. Video Objective: To demonstrate the accuracy of dissection of the double bipolar method in robotic surgery. We will show operative techniques used in real surgical settings for procedures such as modified radical hysterectomy and retroperitoneal lymphadenectomy for clinical stage I endometrial cancer. Setting: Urban general hospital in Japan. Patients: From December 26, 2018 to April 22, 2019, 21 patients underwent these techniques. Interventions: We performed robotic modified radical hysterectomy and bilateral salpingo-oorphrectomy with pelvic lymphadenectomy robotically on a clinical stage Ia case (grade 1-2 histology). Some patients also underwent laparoscopic extraperitoneal paraaortic lymphadenectomy, and the case shown was clinical stage Ib (or grade 3 histology). This technique was pioneered by Prof Ichiro Uyama, a robotic gastrointestinal surgeon. We use robotic Maryland forceps as the cutting device with a Valleylab FT10 energy platform (ForceTriad energy platform) at macromode 60W. The advantage of this technique is that many of the concerns surrounding the use of other instrumentation such as monopolar scissors, where adjacent tissue may be inadvertently injured, are removed by the pinpoint