- Email: [email protected]
47: The role of virtual reality simulation in the evaluation of laparoscopic skills in gynecology
Non-Oral Posters contained fashion. Two had seen and performed manual morcellation abdominally, only one performed it in a contained fashion. The mean confidence level with contained manual tissue extraction of a large specimen increased from 1.83 before the intervention to 4.17 (SD ¼ 0.41, p ¼ 0.001) after the intervention on a 5-point Likert scale. There was no statistically significant difference in tissue extraction timing. CONCLUSION: Our residents are rarely exposed to morcellation techniques, particularly in a contained fashion. Among fourth-year residents, this low fidelity simulation statistically significantly improved their confidence level in regard to contained manual tissue extraction of a large specimen. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Christina A. Saad: Nothing to disclose; Claire Templeman: Nothing to disclose; Jenny M. Jaque: Nothing to disclose; Michael Minneti: Nothing to disclose.
47 The role of virtual reality simulation in the evaluation of laparoscopic skills in gynecology S. Mathews, F. Friedman, A. Weinberg, M. Brodman, C. Ascher-Walsh Icahn School of Medicine at Mount Sinai, New York, NY
OBJECTIVES: To determine if the parameters of performance for
validated laparoscopic virtual simulation tasks correlate with selfreported characteristics and case volumes of practicing obstetricians and gynecologists. MATERIALS AND METHODS: All obstetricians and gynecologists with laparoscopic privileges at a single institution were required to complete a pre-test survey and a series of virtual reality simulation tasks on the Surgical Science LapSimÒ laparoscopic simulator. The assessment was completed by 86 physicians with a median of 15 years in practice and included both generalists (71%) and fellowship-trained specialists. All participants completed a self-report survey about residency training, exposure to simulation and/or video games, general perception of skills, and their average monthly case volumes. They then performed 3 basic skill tasks on the LapSimÒ simulator. Correlations between the survey responses and the time, error, and economy of movement for each task were statistically assessed using a regression model. We focused on the variables most highly associated with the outcomes of interest (p < 0.05). RESULTS: The physicians with higher self-perception of laparoscopic skills (mean ¼ 6.7, scale of 1-10) completed the ring to peg transfer (p < 0.0001) and lifting and grasping task (p ¼ 0.04) more quickly, with fewer drops per transfer (p ¼ 0.002). Those who have been in practice longer (range 0-50 years) were slower to complete the ring to peg transfer (p ¼ 0.006) and the lifting and grasping task (p ¼ 0.008). They also had more drops per transfer (p ¼ 0.02), more tissue damage during lifting and grasping (p < 0.001), and higher rip failure and damage scores during the cutting task (p < 0.001, p ¼ 0.03). Physicians who had fellowship training were faster in completing ring to peg transfer (p ¼ 0.01) and had lower damage scores during cutting (p ¼ 0.01). Physicians who reported an average of 6 to 10 laparoscopic cases per month and 11 or more cases per month were, respectively, 26.7 seconds and 37.7 seconds faster in completing the cutting task than those who reported less than 5 cases per month (p ¼ 0.03, p ¼ 0.004). CONCLUSION: Simulation is gaining traction as a method of technical skill training and assessment in a variety of medical specialties. This is the first study to assess simulator performance among practicing obstetricians and gynecologists and explores correlations to their
ajog.org surgical training and practice. There are significant improvements in scores in those who completed residency training more recently and in those who have had fellowship training. These two factors presumably lead to higher self-perception of laparoscopic skills, which also significantly correlates with better scores. We have identified at least one simulation outcome measure that differentiates between low and high volume surgeons, suggesting that an expected level of performance can be established based on simulator performance. By determining performance as it correlates to active physician practice, there is an opportunity to assess skill and individualize training to maintain skill levels as case volumes fluctuate. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Shyama Mathews: Nothing to disclose; Frederick Friedman: Nothing to disclose; Alan Weinberg: Nothing to disclose; Michael Brodman: Nothing to disclose; Charles Ascher-Walsh: Nothing to disclose.
48 Perioperative complications following colpocleisis with concomitant vaginal hysterectomy K. Bochenska, A. Leader-Cramer, M. G. Mueller, B. Dave, C. Lewicky-Gaupp, A. Alverdy, K. Kenton Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL
OBJECTIVES: To identify and compare surgical characteristics and 30day perioperative complications in patients who underwent colpocleisis with and without concomitant vaginal hysterectomy (VH) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. MATERIALS AND METHODS: Women who underwent vaginal closure procedures from 2006 to 2013 were identified in the ACS-NSQIP database utilizing Current Procedural Terminology (CPT) codes for Le Fort colpocleisis (57120) and vaginectomy (57110). Patients undergoing a concomitant VH were identified by CPT codes ranging from 58260 to 58294. Variables including patient demographics, operative time, hospital length of stay (LOS), transfusion, and reoperation were evaluated. Specific medical complications, surgical site infection, and urinary tract infection (UTI) rates were calculated. Variables were analyzed using chi-squared tests and student’s t-tests for categorical and continuous variables, respectively. RESULTS: We identified 740 women in the ACS-NSQIP database who underwent colpocleisis between 2006 and 2013. The majority (86.4%) underwent colpocleisis alone without VH and 101 patients (13.6%) underwent colpocleisis with VH. Patients undergoing colpocleisis alone were on average older than patients undergoing colpocleisis with VH (mean 79 vs. 77 yrs, p < 0.05) but did not differ in race (p ¼ 0.12) or BMI (p ¼ 0.51). There were no significant differences in medical comorbidities including diabetes (p ¼ 0.48), tobacco use (p ¼ 0.83), COPD (p ¼ 0.47), congestive heart failure (p ¼ 0.45) or hypertension (p ¼ 0.61) between the two groups. Operative time was shorter for patients undergoing colpocleisis alone as compared to those with VH (103 vs. 138 minutes, p < 0.001). Mean hospital length of stay (p ¼ 0.90), transfusion rates (11/639, 1.7% vs. 1/101, 1%, p ¼ 0.58) and need for reoperation (13/639, 2.0% vs. 1/101, 1.0%, p ¼ 0.48) were not different between the two groups. Serious medical complications were more common in women undergoing concomitant VH (5/639, 0.8% vs. 4/101, 4.0%, p < 0.01) (Table). There was no difference in superficial surgical site infection rates between the two groups (4/639, 0.6% vs. 1/101, 1.0%, p ¼ 0.68). UTI was the most common post-operative complication (colpocleisis 32/639, 5.0% vs. colpocleisis with VH 2/ 101, 2.0%, p ¼ 0.18).
S492 American Journal of Obstetrics & Gynecology Supplement to APRIL 2016
47 The role of virtual reality simulation in the evaluation of laparoscopic skills in gynecology S. Mathews, F. Friedman, A. Weinberg, M. Brodman, C. Ascher-Walsh Icahn School of Medicine at Mount Sinai, New York, NY
OBJECTIVES: To determine if the parameters of performance for
validated laparoscopic virtual simulation tasks correlate with selfreported characteristics and case volumes of practicing obstetricians and gynecologists. MATERIALS AND METHODS: All obstetricians and gynecologists with laparoscopic privileges at a single institution were required to complete a pre-test survey and a series of virtual reality simulation tasks on the Surgical Science LapSimÒ laparoscopic simulator. The assessment was completed by 86 physicians with a median of 15 years in practice and included both generalists (71%) and fellowship-trained specialists. All participants completed a self-report survey about residency training, exposure to simulation and/or video games, general perception of skills, and their average monthly case volumes. They then performed 3 basic skill tasks on the LapSimÒ simulator. Correlations between the survey responses and the time, error, and economy of movement for each task were statistically assessed using a regression model. We focused on the variables most highly associated with the outcomes of interest (p < 0.05). RESULTS: The physicians with higher self-perception of laparoscopic skills (mean ¼ 6.7, scale of 1-10) completed the ring to peg transfer (p < 0.0001) and lifting and grasping task (p ¼ 0.04) more quickly, with fewer drops per transfer (p ¼ 0.002). Those who have been in practice longer (range 0-50 years) were slower to complete the ring to peg transfer (p ¼ 0.006) and the lifting and grasping task (p ¼ 0.008). They also had more drops per transfer (p ¼ 0.02), more tissue damage during lifting and grasping (p < 0.001), and higher rip failure and damage scores during the cutting task (p < 0.001, p ¼ 0.03). Physicians who had fellowship training were faster in completing ring to peg transfer (p ¼ 0.01) and had lower damage scores during cutting (p ¼ 0.01). Physicians who reported an average of 6 to 10 laparoscopic cases per month and 11 or more cases per month were, respectively, 26.7 seconds and 37.7 seconds faster in completing the cutting task than those who reported less than 5 cases per month (p ¼ 0.03, p ¼ 0.004). CONCLUSION: Simulation is gaining traction as a method of technical skill training and assessment in a variety of medical specialties. This is the first study to assess simulator performance among practicing obstetricians and gynecologists and explores correlations to their
ajog.org surgical training and practice. There are significant improvements in scores in those who completed residency training more recently and in those who have had fellowship training. These two factors presumably lead to higher self-perception of laparoscopic skills, which also significantly correlates with better scores. We have identified at least one simulation outcome measure that differentiates between low and high volume surgeons, suggesting that an expected level of performance can be established based on simulator performance. By determining performance as it correlates to active physician practice, there is an opportunity to assess skill and individualize training to maintain skill levels as case volumes fluctuate. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Shyama Mathews: Nothing to disclose; Frederick Friedman: Nothing to disclose; Alan Weinberg: Nothing to disclose; Michael Brodman: Nothing to disclose; Charles Ascher-Walsh: Nothing to disclose.
48 Perioperative complications following colpocleisis with concomitant vaginal hysterectomy K. Bochenska, A. Leader-Cramer, M. G. Mueller, B. Dave, C. Lewicky-Gaupp, A. Alverdy, K. Kenton Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL
OBJECTIVES: To identify and compare surgical characteristics and 30day perioperative complications in patients who underwent colpocleisis with and without concomitant vaginal hysterectomy (VH) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. MATERIALS AND METHODS: Women who underwent vaginal closure procedures from 2006 to 2013 were identified in the ACS-NSQIP database utilizing Current Procedural Terminology (CPT) codes for Le Fort colpocleisis (57120) and vaginectomy (57110). Patients undergoing a concomitant VH were identified by CPT codes ranging from 58260 to 58294. Variables including patient demographics, operative time, hospital length of stay (LOS), transfusion, and reoperation were evaluated. Specific medical complications, surgical site infection, and urinary tract infection (UTI) rates were calculated. Variables were analyzed using chi-squared tests and student’s t-tests for categorical and continuous variables, respectively. RESULTS: We identified 740 women in the ACS-NSQIP database who underwent colpocleisis between 2006 and 2013. The majority (86.4%) underwent colpocleisis alone without VH and 101 patients (13.6%) underwent colpocleisis with VH. Patients undergoing colpocleisis alone were on average older than patients undergoing colpocleisis with VH (mean 79 vs. 77 yrs, p < 0.05) but did not differ in race (p ¼ 0.12) or BMI (p ¼ 0.51). There were no significant differences in medical comorbidities including diabetes (p ¼ 0.48), tobacco use (p ¼ 0.83), COPD (p ¼ 0.47), congestive heart failure (p ¼ 0.45) or hypertension (p ¼ 0.61) between the two groups. Operative time was shorter for patients undergoing colpocleisis alone as compared to those with VH (103 vs. 138 minutes, p < 0.001). Mean hospital length of stay (p ¼ 0.90), transfusion rates (11/639, 1.7% vs. 1/101, 1%, p ¼ 0.58) and need for reoperation (13/639, 2.0% vs. 1/101, 1.0%, p ¼ 0.48) were not different between the two groups. Serious medical complications were more common in women undergoing concomitant VH (5/639, 0.8% vs. 4/101, 4.0%, p < 0.01) (Table). There was no difference in superficial surgical site infection rates between the two groups (4/639, 0.6% vs. 1/101, 1.0%, p ¼ 0.68). UTI was the most common post-operative complication (colpocleisis 32/639, 5.0% vs. colpocleisis with VH 2/ 101, 2.0%, p ¼ 0.18).
S492 American Journal of Obstetrics & Gynecology Supplement to APRIL 2016