Assessment of a Practical 2-Hour Simulation-Based Robotic Training Curriculum for Residents: A Randomized Controlled Trial

Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 cases (CI -52 to -33). Rate of intraoperative organ injury was 1% versus 6% (p\0.01), ureteral injury 0% versus 3% (p=0.02), conversion to open 0% versus 5% (p\0.01), intraoperative consult 0.05% versus 7% (p\0.01), and length of stay 1.01 days versus 1.16 days (p\0.01) for proctored versus non-proctored cases respectively. Relative risk of organ injury in the non-proctored group versus the proctored group was 6.5 (CI 1.46-29). Conclusion: A novel surgical proctoring model for minimally invasive gynecology decreased rates of benign abdominal hysterectomy over three years at a community hospital. Proctored laparoscopic hysterectomies had shorter operative times, fewer intraoperative organ injuries, fewer ureteral injuries, fewer conversions to open, fewer intraoperative consults and shorter length of stay as compared to non-proctored cases. 7

Open Communications 1 - Robotics (11:00 AM - 11:05 AM)

Reproductive Outcomes of Robotic Versus Open Myomectomy Performed By One Surgeon Van Heertum K,1 Murphy E,2 Dean L,1 Parent E,1 Marks B,3 Somkuti S,4 Nichols J,4 Schinfeld J,4 Sobel M,4 Barmat L.4 1Ob/Gyn, Abington Memorial Hospital, Abington, Pennsylvania; 2Reproductive Endocrinology and Infertility, Weill Cornell Medical Center, New York, New York; 3Trinity School of Medicine, Kingstown, Saint Vincent and the Grenadines; 4Abington Reproductive Medicine, Abington, Pennsylvania Study Objective: To compare pregnancy outcomes following robotic and open myomectomy. Design: Retrospective cohort study. Setting: Community hospital. Patients: 235 patients underwent myomectomy by a single surgeon from 2001 to 2011: 101 open and 234 robotic-assisted. Measurements and Main Results: Data was gathered from hospital records, telephone interviews, and mailed questionnaires. Pregnancy rate, birth rate, mode of delivery and pregnancy complications (preterm labor/ dilation, preterm premature rupture of membranes, intrauterine fetal growth restriction, preeclampsia/gestational hypertension, abnormal placentation and gestational diabetes) were compared between both groups. SPSS was used for statistical analysis. Age, parity, and body mass index (BMI) were similar between the two groups. There was no statistically significant difference in pregnancy, live birth, miscarriage or cesarean section rates between the two groups. Myomectomy was reported as the reason for primary cesarean section in 17% of patients in the open group versus 9% in the robotic group (p=0.117). Few complications were reported in either group, but there was no statistically significant difference. No uterine ruptures were reported. Data are summarized in Table 1, with data presented as meanstandard deviation where appropriate. Conclusion: Robotic-assisted laparoscopic myomectomy is a minimally invasive alternative to laparotomy in patients desiring future fertility. There were few complications in either group, and the use of the robot does not appear to have a negative effect on fertility outcomes in comparison to open myomectomy. Further study is needed to assess the true incidence of pregnancy complications in these two groups. Table 1

Age (years) Parity Nulliparous Multiparous BMI (kg/m2) Pregnancy Rate Live Birth Rate Miscarriage Rate Cesarean Section Rate Complication Rate

Open

Robotic

p value

36.635.66

36.215.80

0.575 0.820

79% (n=80) 15% (n=15) 27.065.58 35% (n=35) 29% (n=29) 17% (n=6) 97% (n=28) 7% (n=7)

70% (n=94) 25% (n=34) 27.405.92 45% (n=60) 28% (n=38) 32% (n=19) 71% (n=27) 3% (n=4)

Statistical significance defined as p\0.05

0.659 0.330 0.964 0.093 0.237 0.214

8

S3

Open Communications 1 - Robotics (11:06 AM - 11:11 AM)

Assessment of a Practical 2-Hour Simulation-Based Robotic Training Curriculum for Residents: A Randomized Controlled Trial Khalil EA, Gonzalez AV, Marfori CQ, Robinson JK III, Moawad G, Opoku-Anani J. Obstetrics and Gynecology, The George Washington University Hospital, Washington, District of Columbia Study Objective: To evaluate the predictive validiity between robotic simulation and operating room performance using a robotic pelvic model; and to evaluate a 2-hour robotic simulation curriculum to establish basic robotic skills. Design: Randomized controlled trial. Setting: The George Washington University Hospital. Patients: Twenty OB/GYN and General surgery residents. Intervention: Residents were randomly assigned to either intervention group (IG) or control group (CG). After orientation to the da Vinci Si Surgical System, both groups view an online Intuitive Surgical training module and complete a baseline performance test consisting of 4 tasks developed by Intuitive Surgical using the SI robot and a robotic pelvic model. Task times and Global Evaluative Assessment of Robotic Skills scores (GEARS) were recorded. The intervention is 2 hours of simulation on the da Vinci Skills Simulator (dVSS) software. Final performances are compared between IG and CG using the same robotic pelvic model used in the pre-test. Measurements and Main Results: The primary outcome measures are GEARS scores and task times. Six out of ten IG residents have completed their 2-hour simulation time on the dVSS and have taken the post-test. Two out of ten CG residents have completed the post-test. Preliminary data demonstrates an average pre-test GEARS score of 20, 23, 21, 19 (out of 30 points) for tasks 1-4, respectively. Intervention group post-test GEARS so far are 27, 27, 26, 23 average points for tasks 1-4, respectively. Average IG improvement times for tasks 1-4 in seconds are 30, 49, 16, and 59, respectively. Conclusion: A proficiency–driven robotic simulation curriculum enables surgical residents to obtain basic robotic skills. The number of consoles available and the restricted access for resident use limits robotic curriculum design. Further studies are required to determine if improved dry lab skills with simulation translates to improvement in actual surgery. 9

Open Communications 1 - Robotics (11:12 AM - 11:17 AM)

Pre-Operative Risk Assessment for Conversion to Laparotomy in Patients Undergoing Gynecologic Robotic Surgeries Bina S, Hunter K, Mama S. Obstetrics and Gynecology, Cooper University Hospital, Camden, New Jersey Study Objective: To evaluate pre-operative and intra-operative risk factors that may increase the risk for conversion to laparotomy in patients undergoing gynecologic robotic surgery. Design: Retrospective case series of all robotic gynecologic procedures performed at one institution from April 2009 to December 2012. Setting: Cooper University Hospital. Patients: Five hundred and thirty four patients that underwent robotic gynecologic surgery at our institution in the stated time frame. Intervention: Retrospective case series. Measurements and Main Results: Conversion rate to laparotomy and preand intra-operative factors influencing the conversion rate to laparotomy. Evaluation of complications associated with robotic gynecologic procedures. Of 534 patients, we identified 530 robotic procedures that met the inclusion criteria. The conversion rate to laparotomy was 6.4% (34 cases). Of the risk factors, higher ASA score (P=0.020), body mass index (BMI) (P=0.012), previous cardiac surgeries (14.7% vs 3.2% p=0.008), cardiovascular disease (p= 0.008) and diabetes (p=0.043) were noted to be risk factors that showed a trend towards higher risk for conversion to laparotomy but did not reach statistical significance. Thirty of the converted cases (88.2%) had dense adhesions, inadequate exposure and/or