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Development and Validation of a Laparoscopic Sacrocolpopexy Simulation Model for Surgical Training
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S50–S94 Conclusion: Traditional laparoscopic sacral colpopexy performed by experienced laparoscopic surgeons is an efficient treatment for symptomatic vaginal vault prolapse and should be considered as a mode of therapy over much more costly and lengthier surgical techniques such as the robotic approach.
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Open Communications 13dUrogynecology (12:47 PMd12:52 PM)
Use of Glue Mesh Fixation for Laparoscopic Sacrocolpopexy: A Retrospective Analysis of 35 Consecutive Cases Estrade JP,1 Gurriet B,1 Crochet P,2 Agostini A.2 1Gynecology Surgery Unit, Bouchard Clinic, Marseille, Paca, France; 2Gynecology Surgery Unit, Conception Hospital, Marseille, Paca, France Study Objective: To evaluate the efficacy and safety of glue mesh fixation for laparoscopic sacrocolpopexy. Design: Retrospective analysis of 35 consecutives cases. Setting: Gynecology surery unit, Bouchard Clinic, Marseille France. Patients: Thirty five women (age range : 35- 85 years) presenting a genital prolaps assessed by a Pelvic Organ Prolapse Quantification (POP-Q) score (stage 2 to 4). Intervention: Modified laparoscopic sacrocolpopexy using a glue to fix the mesh to the vagina (anterior and posterior) and to the lavator ani. Two non absobable knots are used to secure the anterior mesh to the isthmus and to the promontary. Measurements and Main Results: The average operative time was 68,4 minutes (45-115 min). No complications occured during the procedure and early post operative course. One patient (2,8%) experienced mesh exposure, and 1 patient (2,8%) experienced a subacute intestinal obstruction resolved by a medical traitement. During a median follow-up of 13,2 months (rang : 6 - 24,7 months), the surgical success rate was 94,3%. (2 recurrences). The patient satisfaction rate was 87%. Conclusion: Glue mesh fixation to the vagina during laparoscopic sacrocolpopexy is safe and effective. This new method of fixation optimizes the laparoscopic sacrocolpopexy procedure.
230
Open Communications 13dUrogynecology (12:53 PMd12:58 PM)
S73
Measurements and Main Results: The ‘Expert’ group included female pelvic reconstructive surgeons (N=5) experienced with laparoscopic sacrocolpopexy and the ‘Trainee’ group (N=15) subjects consisted of fourth year gynecology residents (N=5) and fellows in Female Pelvic Medicine and Reconstructive Surgery and Minimally Invasive Gynecology (N=10). The majority of subjects ‘agreed’ or ‘strongly agreed’ that the model was authentic to the live procedure and a useful training tool. ‘Experts’ performed significantly better than ‘Trainees’ in every domain of the GOALS scale as well as in the 3 additional metrics. Table 1 Construct Validity: Time (minutes) and performance (median score [range]) on the simulation model Trainees (n=15) Experts (n=5) Time (minutes) 13.28 (7.3-17.3) 10.53 (8.5-14.9) GOALS metrics Depth perception 3 (2-5) 4 (4-5) Bimanual dexterity 3 (3-5) 3 (3-5) Efficiency 2 (1-3) 4 (3-5) Tissue handeling 3 (2-5) 3 (2-5) Autonomy 3 (2-5) 5 (4-5) GOALS Total score (25 points) 14 (9-22) 23 (19-24) Novel Metrics Needle handling 3 (2-5) 5 (4-5) Knot tying 3 (1-5) 5 (2-5) Mesh fixation 3 (1-4) 4 (4-5) Total score (40 points) 20 (12-31) 32 (28-34)
p 0.32 0.01 0.01 0.01 0.03 0.004 0.001 0.02 0.05 0.001 0.003
GOALS: Global Overall Operative Assessment of Laparoscopic Skills. Each metric is scored from 1 to 5, with a maximum total GOALS score of 25. Combined with 3 novel metrics, the maximum possible score is 40 points. Median total scores were significantly better for ‘Expert’ group compared to the ‘Trainee’ group (32 (28-34) vs. 20 (12-31), p=0.0034). Previous surgical experience had a strong association with performance on the model (Rho > 0.80). Conclusion: Superior performance on the model by more experienced surgeons demonstrates construct validity of this model.
Development and Validation of a Laparoscopic Sacrocolpopexy Simulation Model for Surgical Training Tunitsky-Bitton E,1 King CR,2 Barber MD,1 Ridgeway B,1 Lee TT,2 Muffly TM,1 Paraiso MF,1 Jelovsek E.1 1Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; 2Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
231
Study Objective: To develop a laparoscopic sacrocolpopexy simulation model and provide data supporting the validity of its use as an assessment and learning tool for performing this procedure. Design: We designed a training model to simulate performing a laparoscopic sacrocolpopexy. Validity testing was performed using experienced pelvic reconstruction surgeons and upper level trainees at two tertiary academic centers. Face validity was measured by asking participants questions related to surgical authenticity and educational value of the model using standard Likert scale responses. Construct validity was measured by comparing model performance between ‘Experts’ and ‘Trainees.’ Videotaped performances were scored by a blinded expert utilizing Global Operative Assessment of Laparoscopic Skills (GOALS) scale. Additionally, three domains including ‘needle handling,’ ‘knot tying,’ and ‘mesh fixation’ were added to the original scale. Wilcoxon Rank Sum was used to compare differences in the GOALS scores and operating times between the two groups. Associations between previous surgical experience and GOALS scores were measured using the Spearman rho correlation coefficient.
This video presents a case of a multiparous 43-year-old with pelvic pain and menorrhagia undergoing a robotic single-site hysterectomy. The objective of this video is to demonstrate a hysterectomy performed using the robotic single-site approach in juxtaposition with a robotic multiport hysterectomy. The benefits and challenges of robotic single-site hysterectomy will also be reviewed. This video introduces an innovative minimally invasive surgical approach, however further research and experience is needed to determine the role of robotic single-site approach, its benefits and clinical application in the context of gynecologic surgery.
Video Session 6dRobotics (12:05 PMd12:13 PM)
Understanding the Spectrum of Multiport and Single-Site Robotics for Hysterectomy Truong MD, Advincula AP. Center for Specialized Gynecology, Florida Hospital Celebration Health, Celebration, Florida
232
Video Session 6dRobotics (12:14 PMd12:23 PM)
Robotic Single Incision Surgery: Umbilical Incision Technique and Docking Procedure Farnam RW. Minimally Invasive Surgery, Texas Institute for Robotic Surgery at Las Palmas Medical Center, El Paso, Texas
229
Open Communications 13dUrogynecology (12:47 PMd12:52 PM)
Use of Glue Mesh Fixation for Laparoscopic Sacrocolpopexy: A Retrospective Analysis of 35 Consecutive Cases Estrade JP,1 Gurriet B,1 Crochet P,2 Agostini A.2 1Gynecology Surgery Unit, Bouchard Clinic, Marseille, Paca, France; 2Gynecology Surgery Unit, Conception Hospital, Marseille, Paca, France Study Objective: To evaluate the efficacy and safety of glue mesh fixation for laparoscopic sacrocolpopexy. Design: Retrospective analysis of 35 consecutives cases. Setting: Gynecology surery unit, Bouchard Clinic, Marseille France. Patients: Thirty five women (age range : 35- 85 years) presenting a genital prolaps assessed by a Pelvic Organ Prolapse Quantification (POP-Q) score (stage 2 to 4). Intervention: Modified laparoscopic sacrocolpopexy using a glue to fix the mesh to the vagina (anterior and posterior) and to the lavator ani. Two non absobable knots are used to secure the anterior mesh to the isthmus and to the promontary. Measurements and Main Results: The average operative time was 68,4 minutes (45-115 min). No complications occured during the procedure and early post operative course. One patient (2,8%) experienced mesh exposure, and 1 patient (2,8%) experienced a subacute intestinal obstruction resolved by a medical traitement. During a median follow-up of 13,2 months (rang : 6 - 24,7 months), the surgical success rate was 94,3%. (2 recurrences). The patient satisfaction rate was 87%. Conclusion: Glue mesh fixation to the vagina during laparoscopic sacrocolpopexy is safe and effective. This new method of fixation optimizes the laparoscopic sacrocolpopexy procedure.
230
Open Communications 13dUrogynecology (12:53 PMd12:58 PM)
S73
Measurements and Main Results: The ‘Expert’ group included female pelvic reconstructive surgeons (N=5) experienced with laparoscopic sacrocolpopexy and the ‘Trainee’ group (N=15) subjects consisted of fourth year gynecology residents (N=5) and fellows in Female Pelvic Medicine and Reconstructive Surgery and Minimally Invasive Gynecology (N=10). The majority of subjects ‘agreed’ or ‘strongly agreed’ that the model was authentic to the live procedure and a useful training tool. ‘Experts’ performed significantly better than ‘Trainees’ in every domain of the GOALS scale as well as in the 3 additional metrics. Table 1 Construct Validity: Time (minutes) and performance (median score [range]) on the simulation model Trainees (n=15) Experts (n=5) Time (minutes) 13.28 (7.3-17.3) 10.53 (8.5-14.9) GOALS metrics Depth perception 3 (2-5) 4 (4-5) Bimanual dexterity 3 (3-5) 3 (3-5) Efficiency 2 (1-3) 4 (3-5) Tissue handeling 3 (2-5) 3 (2-5) Autonomy 3 (2-5) 5 (4-5) GOALS Total score (25 points) 14 (9-22) 23 (19-24) Novel Metrics Needle handling 3 (2-5) 5 (4-5) Knot tying 3 (1-5) 5 (2-5) Mesh fixation 3 (1-4) 4 (4-5) Total score (40 points) 20 (12-31) 32 (28-34)
p 0.32 0.01 0.01 0.01 0.03 0.004 0.001 0.02 0.05 0.001 0.003
GOALS: Global Overall Operative Assessment of Laparoscopic Skills. Each metric is scored from 1 to 5, with a maximum total GOALS score of 25. Combined with 3 novel metrics, the maximum possible score is 40 points. Median total scores were significantly better for ‘Expert’ group compared to the ‘Trainee’ group (32 (28-34) vs. 20 (12-31), p=0.0034). Previous surgical experience had a strong association with performance on the model (Rho > 0.80). Conclusion: Superior performance on the model by more experienced surgeons demonstrates construct validity of this model.
Development and Validation of a Laparoscopic Sacrocolpopexy Simulation Model for Surgical Training Tunitsky-Bitton E,1 King CR,2 Barber MD,1 Ridgeway B,1 Lee TT,2 Muffly TM,1 Paraiso MF,1 Jelovsek E.1 1Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio; 2Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
231
Study Objective: To develop a laparoscopic sacrocolpopexy simulation model and provide data supporting the validity of its use as an assessment and learning tool for performing this procedure. Design: We designed a training model to simulate performing a laparoscopic sacrocolpopexy. Validity testing was performed using experienced pelvic reconstruction surgeons and upper level trainees at two tertiary academic centers. Face validity was measured by asking participants questions related to surgical authenticity and educational value of the model using standard Likert scale responses. Construct validity was measured by comparing model performance between ‘Experts’ and ‘Trainees.’ Videotaped performances were scored by a blinded expert utilizing Global Operative Assessment of Laparoscopic Skills (GOALS) scale. Additionally, three domains including ‘needle handling,’ ‘knot tying,’ and ‘mesh fixation’ were added to the original scale. Wilcoxon Rank Sum was used to compare differences in the GOALS scores and operating times between the two groups. Associations between previous surgical experience and GOALS scores were measured using the Spearman rho correlation coefficient.
This video presents a case of a multiparous 43-year-old with pelvic pain and menorrhagia undergoing a robotic single-site hysterectomy. The objective of this video is to demonstrate a hysterectomy performed using the robotic single-site approach in juxtaposition with a robotic multiport hysterectomy. The benefits and challenges of robotic single-site hysterectomy will also be reviewed. This video introduces an innovative minimally invasive surgical approach, however further research and experience is needed to determine the role of robotic single-site approach, its benefits and clinical application in the context of gynecologic surgery.
Video Session 6dRobotics (12:05 PMd12:13 PM)
Understanding the Spectrum of Multiport and Single-Site Robotics for Hysterectomy Truong MD, Advincula AP. Center for Specialized Gynecology, Florida Hospital Celebration Health, Celebration, Florida
232
Video Session 6dRobotics (12:14 PMd12:23 PM)
Robotic Single Incision Surgery: Umbilical Incision Technique and Docking Procedure Farnam RW. Minimally Invasive Surgery, Texas Institute for Robotic Surgery at Las Palmas Medical Center, El Paso, Texas