- Email: [email protected]
53: The value of using visuospatial ability testing to determine surgical performance in gynecological residents
Non-Oral Posters
ajog.org omental J flap, and cystoscopy. Intraoperative findings included enlarged multinodular thyroid gland, uterine didelphys with right uterine horn hematomata and cervical agenesis, left uterine horn with adjacent leiomyomas and rudimentary cervix, normal fallopian tubes and ovaries bilaterally, thick transverse vaginal septum, and no obvious vesicovaginal fistula (VVF) but possible obliterated VVF. Postoperative course was uncomplicated. The patient’s preoperative pain and thyrotoxicosis symptoms completely resolved by the time of hospital dismissal. CONCLUSION: As our case demonstrates, complex Mullerian and reproductive track outflow anomalies may go undiagnosed with suboptimal care for many years unless appropriate history, physical examination, and imaging are performed. Earlier diagnosis and surgical correction could have allowed our patient significantly reduced morbidity and even fertility sparing treatment. Although the gold standard for Mullerian anomalies, MRI may not always provide precise diagnoses prior to surgery, thereby requiring coordination of multiple specialists to prepare for all possible anatomic variations. In this case, multidisciplinary approach resulted in optimal surgical outcome, resolution of over a decade of patient suffering and normalization of her life. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Jessica R. Kanter: Nothing to disclose; Khilen B. Patel: Nothing to disclose; Lawren E. Honken: Nothing to disclose; Larisa GavrilovaJordan: Nothing to disclose.
52 Patient factors associated with route of hysterectomy for benign indications A. R. Carrubba1, G. Whitmore1, T. Muffly2 1 Obstetrics and Gynecology, University of Colorado, Denver, CO, 2Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO
OBJECTIVES: Hysterectomies are performed vaginally, abdominally,
or with laparoscopic or robotic assistance. Although minimally invasive routes are associated with fewer complications, prior studies have shown that women of lower socioeconomic status are less likely to undergo laparoscopic hysterectomy. We aim to analyze the association between patient demographic characteristics and the probability of undergoing abdominal (AH), laparoscopic (LH), robotic (RH), and vaginal hysterectomy (VH) in our hospital system. MATERIALS AND METHODS: All hysterectomies performed at our institution from September 2011 to May 2015 were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and reviewed in the electronic medical record for accuracy. Exclusion criteria were malignancy and hysterectomy performed within 6 weeks postpartum. Statistical analysis was performed using JMP Pro Version 11.2 and consisted of descriptive statistics, students’ T-tests, and Analysis of Variance tests. RESULTS: There were 2,742 hysterectomies for benign, non-obstetric indications (AH 17.5%, LH 33.4%, RH 32.3%, and VH 16.7%). Patient characteristics associated with AH included high body mass index (BMI), “other” race, Hispanic ethnicity, high American Society of Anesthesiologists (ASA) status, self-pay insurance, resident involvement, and academic hospital type. The LH and RH groups were similar, with the highest rates of white patients, non-Hispanic ethnicity, private insurance, English language, and community hospital type. CONCLUSION: Patients undergoing LH and RH were associated with demographic characteristics suggestive of higher socioeconomic status than those undergoing AH. These findings support the hypothesis that disparities exist in access to minimally invasive hysterectomy.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Aakriti R. Carrubba: Nothing to disclose; Gabrielle Whitmore: Nothing to disclose; Tyler Muffly: Nothing to disclose.
53 The value of using visuospatial ability testing to determine surgical performance in gynecological residents K. Hoan1, J. Doneza1, R. Barr2, C. Ascher-Walsh1 1
OB/GYN, Mt Sinai, Queens, NY, 2OB/GYN, NYU, NYC, NY
OBJECTIVES: To examine the relationship between visuospatial ability
testing as a predictor of performance in surgery among gynecology residents. To determine if visuospatial ability scores are constant or if they change with increased exposure to surgical procedures.
Supplement to MARCH 2017 American Journal of Obstetrics & Gynecology
S605
Non-Oral Posters MATERIALS AND METHODS: This was a prospective, non-blinded study involving the gynecological residents over two academic years. This study took place at a single academic teaching center, Mt Sinai Hospital, in Manhattan, NY. Over two academic years, residents completed three visuospatial ability tests (snowy pictures, card rotation and form board) on two separate occasions and were evaluated on their performance in gynecologic surgeries using the Hopkins Assessment of Surgical Competency, a validated global rating scale consisting of the general skills and case skills subscales. Evaluations were included when the resident acted as the primary surgeon or first assistant and were excluded if the resident was the second assistant, or had not completed the visuospatial ability tests two times, one year apart. RESULTS: Between August 2014 and July 2016, 37 residents were enrolled and 468 surgical evaluations were included. Three visuospatial ability tests were compared to two years of surgical data, which demonstrated a trending correlation that was not statistically significant. As the card rotation test increased, so did the general skills (p ¼ 0.08) and case skills (p ¼ 0.04). There was no correlation between general skills (GS) or case skills (CS) and snowy pictures or form board. Eighteen residents took all three portions of the visuospatial ability tests on two separate occasions, one year apart. Comparing year 1 to year 2, the form board and snowy picture tests remained constant (p ¼ 0.0.17) and (p ¼ 0.24) respectively. The card score did increase significantly (p ¼ 0.0051). The residents’ general skills and case skills did not significantly increase from year 1 (GS: 3.6/ CS: 3.66) to year 2 (GS 3.62/ CS: 3.52). CONCLUSION: Higher scores on the more complex visuospatial ability test trended towards better performance in the operating room. The form board and snowy picture test remained constant, making them useful tests in predicting surgical performance regardless of an individual’s exposure to the operating room or previous visuospatial ability tests. Surgical skill (GS + CS) remained constant through the two years evaluations. Although higher card rotation scores correlated with higher scores in the operating room these scores also increased with time, limiting their usability in this type of testing. Longer-term evaluation of this testing is necessary to demonstrate its usefulness in pre-determination of surgical ability.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Karina Hoan: Nothing to disclose; Janine Doneza: Nothing to disclose; Rachel Barr: Nothing to disclose; Charles Ascher-Walsh: Nothing to disclose.
54 Effectiveness of assessing ureteral patency using pre operative phenazopyridine Z. Chaudhry1,2, E. Strom1,2, A. Maisonet1, C. Wieslander2,1
ajog.org Patient demographics including age, reason for surgery, renal function via serum creatinine and glomerular filtration rate were recorded. Operative time was recorded. Operative reports, anesthesia records, and discharge summaries were reviewed to determine if phenazopyridine was given pre operatively and if additional agents were used to assess ureteral flow. Complications due to medication administration were abstracted from the chart. Descriptive statistics were performed. Continuous variables were compared using a t-test. A p value <0.05 was deemed to be significant. RESULTS: A total of 206 patients were identified who received phenazopyridine prior to gynecologic surgery. One hundred ninety-four patients (94.2%) had adequate ureteral flow identification with just phenazopyridine, 11 (5.3%) patients required additional sodium fluorescein, and 1 (0.5%) underwent a retrograde pyelogram. If a secondary agent was used, no additional agents were needed to confirm ureteral flow. No intra-operative adverse events were noted with phenazopyridine use followed by sodium fluorescein. Intra operatively, 1 ureteral injury (which was verified by retrograde pyelogram) and 1 cystotomy were identified in patients who only received phenazopyridine. There was no delayed recognition of injury to the ureters or bladder in the entire group of patients. There was no difference in mean age, body mass index, glomerular filtration rate, serum creatinine, or operative time between patients who only needed phenazopyridine to identify ureteral flow and those who needed sodium fluorescein in addition (Figure 1). CONCLUSION: Phenazopyridine allowed for ureteral flow identification in a majority of cases. Sodium fluorescein was the most commonly used secondary agent and allowed for ureteral flow identification even if phenazopyridine had previously been given. Larger studies are needed to determine patient factors that minimize the effectiveness of phenazopyridine use to detect ureteral flow.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Zaid Chaudhry: Nothing to disclose; Elizabeth Strom: Nothing to disclose; Axeline Maisonet: Nothing to disclose; Cecilia Wieslander: Nothing to disclose.
55 Five years experience with porcine extracellular matrix as an alternative to synthetics in pelvic reconstruction surgery for pelvic organ prolapse
1 Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 2Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA
J. V. Storey, R. Yordan, S. M. Kambiss
OBJECTIVES: There is a lack of information on the overall effectiveness of phenazopyridine use to detect ureteral flow during gynecologic surgery. Since it is an oral agent, it can potentially have an unpredictable excretion time. The purpose of this study is to describe the effectiveness of phenazopyridine use for determining ureteral flow and the need for secondary agents if ureteral flow identification was initially inadequate. MATERIALS AND METHODS: This is an IRB approved retrospective study performed at the Olive View-UCLA Medical Center from January 2014 to August 2016. Patients undergoing hysterectomy or urogynecologic procedures were identified through medical records.
OBJECTIVES: Retrospective case series report on the efficacy and
Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
safety of using the porcine extracellular matrix MatristemÒ (ACell, Columbia, MD) in the surgical management of pelvic organ prolapse (POP). MATERIALS AND METHODS: Charts of patients treated surgically for POP with a porcine bladder graft at our institution between 2010 and 2014 were reviewed. Pre and postoperative POP-Q scores were compared. Surgical complications and adverse events were surveyed. RESULTS: Sixty-nine patients were identified with POP including 75 pelvic reconstructive procedures performed. Forty-eight anterior repairs (AR) including 14 total vaginal hysterectomies with modified
S606 American Journal of Obstetrics & Gynecology Supplement to MARCH 2017
ajog.org omental J flap, and cystoscopy. Intraoperative findings included enlarged multinodular thyroid gland, uterine didelphys with right uterine horn hematomata and cervical agenesis, left uterine horn with adjacent leiomyomas and rudimentary cervix, normal fallopian tubes and ovaries bilaterally, thick transverse vaginal septum, and no obvious vesicovaginal fistula (VVF) but possible obliterated VVF. Postoperative course was uncomplicated. The patient’s preoperative pain and thyrotoxicosis symptoms completely resolved by the time of hospital dismissal. CONCLUSION: As our case demonstrates, complex Mullerian and reproductive track outflow anomalies may go undiagnosed with suboptimal care for many years unless appropriate history, physical examination, and imaging are performed. Earlier diagnosis and surgical correction could have allowed our patient significantly reduced morbidity and even fertility sparing treatment. Although the gold standard for Mullerian anomalies, MRI may not always provide precise diagnoses prior to surgery, thereby requiring coordination of multiple specialists to prepare for all possible anatomic variations. In this case, multidisciplinary approach resulted in optimal surgical outcome, resolution of over a decade of patient suffering and normalization of her life. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Jessica R. Kanter: Nothing to disclose; Khilen B. Patel: Nothing to disclose; Lawren E. Honken: Nothing to disclose; Larisa GavrilovaJordan: Nothing to disclose.
52 Patient factors associated with route of hysterectomy for benign indications A. R. Carrubba1, G. Whitmore1, T. Muffly2 1 Obstetrics and Gynecology, University of Colorado, Denver, CO, 2Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO
OBJECTIVES: Hysterectomies are performed vaginally, abdominally,
or with laparoscopic or robotic assistance. Although minimally invasive routes are associated with fewer complications, prior studies have shown that women of lower socioeconomic status are less likely to undergo laparoscopic hysterectomy. We aim to analyze the association between patient demographic characteristics and the probability of undergoing abdominal (AH), laparoscopic (LH), robotic (RH), and vaginal hysterectomy (VH) in our hospital system. MATERIALS AND METHODS: All hysterectomies performed at our institution from September 2011 to May 2015 were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and reviewed in the electronic medical record for accuracy. Exclusion criteria were malignancy and hysterectomy performed within 6 weeks postpartum. Statistical analysis was performed using JMP Pro Version 11.2 and consisted of descriptive statistics, students’ T-tests, and Analysis of Variance tests. RESULTS: There were 2,742 hysterectomies for benign, non-obstetric indications (AH 17.5%, LH 33.4%, RH 32.3%, and VH 16.7%). Patient characteristics associated with AH included high body mass index (BMI), “other” race, Hispanic ethnicity, high American Society of Anesthesiologists (ASA) status, self-pay insurance, resident involvement, and academic hospital type. The LH and RH groups were similar, with the highest rates of white patients, non-Hispanic ethnicity, private insurance, English language, and community hospital type. CONCLUSION: Patients undergoing LH and RH were associated with demographic characteristics suggestive of higher socioeconomic status than those undergoing AH. These findings support the hypothesis that disparities exist in access to minimally invasive hysterectomy.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Aakriti R. Carrubba: Nothing to disclose; Gabrielle Whitmore: Nothing to disclose; Tyler Muffly: Nothing to disclose.
53 The value of using visuospatial ability testing to determine surgical performance in gynecological residents K. Hoan1, J. Doneza1, R. Barr2, C. Ascher-Walsh1 1
OB/GYN, Mt Sinai, Queens, NY, 2OB/GYN, NYU, NYC, NY
OBJECTIVES: To examine the relationship between visuospatial ability
testing as a predictor of performance in surgery among gynecology residents. To determine if visuospatial ability scores are constant or if they change with increased exposure to surgical procedures.
Supplement to MARCH 2017 American Journal of Obstetrics & Gynecology
S605
Non-Oral Posters MATERIALS AND METHODS: This was a prospective, non-blinded study involving the gynecological residents over two academic years. This study took place at a single academic teaching center, Mt Sinai Hospital, in Manhattan, NY. Over two academic years, residents completed three visuospatial ability tests (snowy pictures, card rotation and form board) on two separate occasions and were evaluated on their performance in gynecologic surgeries using the Hopkins Assessment of Surgical Competency, a validated global rating scale consisting of the general skills and case skills subscales. Evaluations were included when the resident acted as the primary surgeon or first assistant and were excluded if the resident was the second assistant, or had not completed the visuospatial ability tests two times, one year apart. RESULTS: Between August 2014 and July 2016, 37 residents were enrolled and 468 surgical evaluations were included. Three visuospatial ability tests were compared to two years of surgical data, which demonstrated a trending correlation that was not statistically significant. As the card rotation test increased, so did the general skills (p ¼ 0.08) and case skills (p ¼ 0.04). There was no correlation between general skills (GS) or case skills (CS) and snowy pictures or form board. Eighteen residents took all three portions of the visuospatial ability tests on two separate occasions, one year apart. Comparing year 1 to year 2, the form board and snowy picture tests remained constant (p ¼ 0.0.17) and (p ¼ 0.24) respectively. The card score did increase significantly (p ¼ 0.0051). The residents’ general skills and case skills did not significantly increase from year 1 (GS: 3.6/ CS: 3.66) to year 2 (GS 3.62/ CS: 3.52). CONCLUSION: Higher scores on the more complex visuospatial ability test trended towards better performance in the operating room. The form board and snowy picture test remained constant, making them useful tests in predicting surgical performance regardless of an individual’s exposure to the operating room or previous visuospatial ability tests. Surgical skill (GS + CS) remained constant through the two years evaluations. Although higher card rotation scores correlated with higher scores in the operating room these scores also increased with time, limiting their usability in this type of testing. Longer-term evaluation of this testing is necessary to demonstrate its usefulness in pre-determination of surgical ability.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Karina Hoan: Nothing to disclose; Janine Doneza: Nothing to disclose; Rachel Barr: Nothing to disclose; Charles Ascher-Walsh: Nothing to disclose.
54 Effectiveness of assessing ureteral patency using pre operative phenazopyridine Z. Chaudhry1,2, E. Strom1,2, A. Maisonet1, C. Wieslander2,1
ajog.org Patient demographics including age, reason for surgery, renal function via serum creatinine and glomerular filtration rate were recorded. Operative time was recorded. Operative reports, anesthesia records, and discharge summaries were reviewed to determine if phenazopyridine was given pre operatively and if additional agents were used to assess ureteral flow. Complications due to medication administration were abstracted from the chart. Descriptive statistics were performed. Continuous variables were compared using a t-test. A p value <0.05 was deemed to be significant. RESULTS: A total of 206 patients were identified who received phenazopyridine prior to gynecologic surgery. One hundred ninety-four patients (94.2%) had adequate ureteral flow identification with just phenazopyridine, 11 (5.3%) patients required additional sodium fluorescein, and 1 (0.5%) underwent a retrograde pyelogram. If a secondary agent was used, no additional agents were needed to confirm ureteral flow. No intra-operative adverse events were noted with phenazopyridine use followed by sodium fluorescein. Intra operatively, 1 ureteral injury (which was verified by retrograde pyelogram) and 1 cystotomy were identified in patients who only received phenazopyridine. There was no delayed recognition of injury to the ureters or bladder in the entire group of patients. There was no difference in mean age, body mass index, glomerular filtration rate, serum creatinine, or operative time between patients who only needed phenazopyridine to identify ureteral flow and those who needed sodium fluorescein in addition (Figure 1). CONCLUSION: Phenazopyridine allowed for ureteral flow identification in a majority of cases. Sodium fluorescein was the most commonly used secondary agent and allowed for ureteral flow identification even if phenazopyridine had previously been given. Larger studies are needed to determine patient factors that minimize the effectiveness of phenazopyridine use to detect ureteral flow.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Zaid Chaudhry: Nothing to disclose; Elizabeth Strom: Nothing to disclose; Axeline Maisonet: Nothing to disclose; Cecilia Wieslander: Nothing to disclose.
55 Five years experience with porcine extracellular matrix as an alternative to synthetics in pelvic reconstruction surgery for pelvic organ prolapse
1 Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 2Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA
J. V. Storey, R. Yordan, S. M. Kambiss
OBJECTIVES: There is a lack of information on the overall effectiveness of phenazopyridine use to detect ureteral flow during gynecologic surgery. Since it is an oral agent, it can potentially have an unpredictable excretion time. The purpose of this study is to describe the effectiveness of phenazopyridine use for determining ureteral flow and the need for secondary agents if ureteral flow identification was initially inadequate. MATERIALS AND METHODS: This is an IRB approved retrospective study performed at the Olive View-UCLA Medical Center from January 2014 to August 2016. Patients undergoing hysterectomy or urogynecologic procedures were identified through medical records.
OBJECTIVES: Retrospective case series report on the efficacy and
Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
safety of using the porcine extracellular matrix MatristemÒ (ACell, Columbia, MD) in the surgical management of pelvic organ prolapse (POP). MATERIALS AND METHODS: Charts of patients treated surgically for POP with a porcine bladder graft at our institution between 2010 and 2014 were reviewed. Pre and postoperative POP-Q scores were compared. Surgical complications and adverse events were surveyed. RESULTS: Sixty-nine patients were identified with POP including 75 pelvic reconstructive procedures performed. Forty-eight anterior repairs (AR) including 14 total vaginal hysterectomies with modified
S606 American Journal of Obstetrics & Gynecology Supplement to MARCH 2017