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Laparoscopic skills assessment of senior obstetrics and gynecologic residents: a city wide experience
group continued to lactate after curettage. All patients desired normal menses and most wished to conceive in the near future. If adhesiolysis by hysteroscopy (HSC) proved too difficult and/or if the patient had had a prior uterine perforation, simultaneous laparoscopy (LSC) was performed. Four patients required hysterotomy. After surgery a uterine stent was placed and high dose estrogen therapy was prescribed. Surgery was repeated if IUA persisted. Results were assessed by restoration of menses, by hysterosalpingogram (HSG), mid-cycle untrasound (U/S) and/or occurrence of pregnancy (PG). RESULTS: Significant differences were noted in the therapies required and outcome relative to the apparent cause:
with a wide variety of experiences. It allows for resident assessment using a regional benchmark and can indicate areas of deficiency in training. Thirty percent of senior residents had no endoscopic suturing experience and 50 percent were unable to complete a single interrupted stitch in the space of 12 minutes. In contrast to our general surgery colleagues, laparoscopic suturing does not appear to be a priority skill among the gynecologic residencies sampled. Supported by: None.
Wednesday, October 17, 2007 3:30 pm
TABLE. Results of therapy for IUA compared to apparent etiology Cause (N)
HSC only
HSC/ LSC
>One Procedure
Normal Menses
Normal HSG
Normal U/S
AB (757)
722
35 (5%) ab
53 (7%) ab
654/682 (96%) ab 29 /113 (26%) ac 118/244 (48%) bc
706/750 (94%) ab 27/105 (26%) ac 117/225 (52%) bc
207/225 (92%) ab 7/34 (21%) ac 40/91 (44%) bc
GS (113)
79
34 (30%) ac
28 (25%) ac
PPH (245)
147
98 (40%) bc
98 (40%) bc
Pg 531/755 (70%) ab 17/111 (15%) ac 78/243 (32%) bc
Values in the same column followed by the same letter differ significantly (P<0.005; Chi2). CONCLUSIONS: IUA formation after either GS or PPH is usually more extensive and more difficult to treat. Prolonged estrogen deficiency may be an important contributing factor to the severity of disease. Current challenges are to anticipate these injuries, to reduce their frequency and severity and to develop techniques that facilitate early diagnosis. Supported by: None.
Wednesday, October 17, 2007 3:15 pm O-287
O-288 LAPAROSCOPIC PROXIMAL TUBAL DIVISION CAN PRESERVE OVARIAN RESERVE FOR INFERTILITY PATIENTS WITH HYDROSALPINGES. A. Nakashima, K. Nakagawa, S. Ohgi, M. Ito, T. Horikawa, H. Saito. Division of Reproductive Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan. OBJECTIVE: To investigate whether laparoscopic proximal tubal division for the treatment of hydrosalpinges could preserve ovarian function, while serum FSH values were measured in infertility patients with hydrosalpinges before and after laparoscopic surgery. DESIGN: Retrospective study. MATERIALS AND METHODS: From June 2002 to October 2006, laparosocopic proximal tubal division (PTD group) was performed on 11 patients and laparoscopic salpingectomy (salpingectomy group) was performed on 6 patients before ART treatment. Basal FSH values in each case before and after laparoscopic surgery were retrospectively compared. The operation times and outcome of ART treatment after the laparosocopic surgery were also evaluated. RESULTS: The mean FSH value before laparoscopic proximal tubal division was similar to that after surgery. The FSH value before laparoscopic salpingectomy significantly increased after surgery (6.8 1.1 vs. 14.1 9.3, P¼0.02, Figure 1). The operation time in the PTD group was significantly shorter than in the salpingectomy group (P¼0.028). The outcome of ART was similar in both groups. The pregnancy rate per patient in the PTD and salpingectomy groups were 45.5% and 50.0%, respectively.
LAPAROSCOPIC SKILLS ASSESSMENT OF SENIOR OBSTETRICS AND GYNECOLOGIC RESIDENTS: A CITY WIDE EXPERIENCE. I. Moy, J. C. Escobar, M. P. Milad. Obstetrics and Gynecology, Northwestern University, Chicago, IL. OBJECTIVE: To establish feasibility and reliability of a laparoscopic skills assessment when administered to senior obstetrics and gynecologic residents trained at multiple programs. DESIGN: Multi-center, prospective, cohort study. MATERIALS AND METHODS: An Objective Structured Assessment of Technical Skills (OSATS) containing 8 skills was administered to 27 senior obstetric and gynecology residents from 5 residency programs in Chicago, IL. The laparoscopic skills station evaluated competency and efficiency of laparoscopic suturing, intracorporeal and extracorporeal knot tying, and usage of endostitch in a specific case scenario. Residents were timed and assessed with 3 types of measures: task-specific checklist, global rating scale of operative performance, and pass/fail grade. Each resident was evaluated by one examiner blinded as to the postgraduate year and program. Two types of reliability were evaluated. Construct validity was assessed using one-way MANOVA with year of clinical training as the independent variable (4 or 5 years) and the station scores as the dependent variables. RESULTS: Ten PGY-3 and 17 PGY-4 residents participated in the exam. Eight of the residents had no experience with laparoscopic suturing. Global rating scale (GRS) of operative performance ranged from 6 to 25 with a maximum score of 30 possible. Those who had no experience in laparoscopic suturing scored the lowest with scores between 6 and 17. The mean score for the GRS was found to be 16.33 1.18 (mean standard error of the mean). The overall pass rate was 50%. The mean score for the task-specific checklist was found to be 3.33 0.41 with a maximum score of 7 possible. Mean time of skills completion was 9.97 0.53 minutes. The overall inter-station reliability for the OSATS was 0.55. Controlling for year of training, overall pass rates were similar between programs. Feedback from residents and faculty was universally positive. CONCLUSIONS: Developing a multiple program OSATS affords the opportunity to achieve economies of scale and draw from multiple colleagues
S108
Abstracts
Figure.
CONCLUSIONS: Laparoscopic proximal tubal division preserved ovarian function and was an optimal operation method for infertility patients with hydrosalpinges. The basal FSH values after laparoscopic proximal tubal division were comparable to those before the surgery. Supported by: None.
Wednesday, October 17, 2007 3:45 pm O-289 REPRODUCTIVE OUTCOME AFTER HYSTEROSCOPIC METROPLASTY IN WOMEN WITH PRIMARY INFERTILITY. M. Abuzeid, M. Imam, K. Sakhel, M. Mitwally, M. Ashraf, M. Diamond. Division of Reproductive Endocrinology and Infertility, Hurley Medical Center, Flint, MI; IVF Michigan PC, Rochester Hills, MI; Synergy Medical Education Alliance, Michigan State, Saginaw, MI; Division of Reproductive Endocrinology and Infertility, Wayne State University, Detroit, MI.
Vol. 88, Suppl 1, September 2007
with a wide variety of experiences. It allows for resident assessment using a regional benchmark and can indicate areas of deficiency in training. Thirty percent of senior residents had no endoscopic suturing experience and 50 percent were unable to complete a single interrupted stitch in the space of 12 minutes. In contrast to our general surgery colleagues, laparoscopic suturing does not appear to be a priority skill among the gynecologic residencies sampled. Supported by: None.
Wednesday, October 17, 2007 3:30 pm
TABLE. Results of therapy for IUA compared to apparent etiology Cause (N)
HSC only
HSC/ LSC
>One Procedure
Normal Menses
Normal HSG
Normal U/S
AB (757)
722
35 (5%) ab
53 (7%) ab
654/682 (96%) ab 29 /113 (26%) ac 118/244 (48%) bc
706/750 (94%) ab 27/105 (26%) ac 117/225 (52%) bc
207/225 (92%) ab 7/34 (21%) ac 40/91 (44%) bc
GS (113)
79
34 (30%) ac
28 (25%) ac
PPH (245)
147
98 (40%) bc
98 (40%) bc
Pg 531/755 (70%) ab 17/111 (15%) ac 78/243 (32%) bc
Values in the same column followed by the same letter differ significantly (P<0.005; Chi2). CONCLUSIONS: IUA formation after either GS or PPH is usually more extensive and more difficult to treat. Prolonged estrogen deficiency may be an important contributing factor to the severity of disease. Current challenges are to anticipate these injuries, to reduce their frequency and severity and to develop techniques that facilitate early diagnosis. Supported by: None.
Wednesday, October 17, 2007 3:15 pm O-287
O-288 LAPAROSCOPIC PROXIMAL TUBAL DIVISION CAN PRESERVE OVARIAN RESERVE FOR INFERTILITY PATIENTS WITH HYDROSALPINGES. A. Nakashima, K. Nakagawa, S. Ohgi, M. Ito, T. Horikawa, H. Saito. Division of Reproductive Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan. OBJECTIVE: To investigate whether laparoscopic proximal tubal division for the treatment of hydrosalpinges could preserve ovarian function, while serum FSH values were measured in infertility patients with hydrosalpinges before and after laparoscopic surgery. DESIGN: Retrospective study. MATERIALS AND METHODS: From June 2002 to October 2006, laparosocopic proximal tubal division (PTD group) was performed on 11 patients and laparoscopic salpingectomy (salpingectomy group) was performed on 6 patients before ART treatment. Basal FSH values in each case before and after laparoscopic surgery were retrospectively compared. The operation times and outcome of ART treatment after the laparosocopic surgery were also evaluated. RESULTS: The mean FSH value before laparoscopic proximal tubal division was similar to that after surgery. The FSH value before laparoscopic salpingectomy significantly increased after surgery (6.8 1.1 vs. 14.1 9.3, P¼0.02, Figure 1). The operation time in the PTD group was significantly shorter than in the salpingectomy group (P¼0.028). The outcome of ART was similar in both groups. The pregnancy rate per patient in the PTD and salpingectomy groups were 45.5% and 50.0%, respectively.
LAPAROSCOPIC SKILLS ASSESSMENT OF SENIOR OBSTETRICS AND GYNECOLOGIC RESIDENTS: A CITY WIDE EXPERIENCE. I. Moy, J. C. Escobar, M. P. Milad. Obstetrics and Gynecology, Northwestern University, Chicago, IL. OBJECTIVE: To establish feasibility and reliability of a laparoscopic skills assessment when administered to senior obstetrics and gynecologic residents trained at multiple programs. DESIGN: Multi-center, prospective, cohort study. MATERIALS AND METHODS: An Objective Structured Assessment of Technical Skills (OSATS) containing 8 skills was administered to 27 senior obstetric and gynecology residents from 5 residency programs in Chicago, IL. The laparoscopic skills station evaluated competency and efficiency of laparoscopic suturing, intracorporeal and extracorporeal knot tying, and usage of endostitch in a specific case scenario. Residents were timed and assessed with 3 types of measures: task-specific checklist, global rating scale of operative performance, and pass/fail grade. Each resident was evaluated by one examiner blinded as to the postgraduate year and program. Two types of reliability were evaluated. Construct validity was assessed using one-way MANOVA with year of clinical training as the independent variable (4 or 5 years) and the station scores as the dependent variables. RESULTS: Ten PGY-3 and 17 PGY-4 residents participated in the exam. Eight of the residents had no experience with laparoscopic suturing. Global rating scale (GRS) of operative performance ranged from 6 to 25 with a maximum score of 30 possible. Those who had no experience in laparoscopic suturing scored the lowest with scores between 6 and 17. The mean score for the GRS was found to be 16.33 1.18 (mean standard error of the mean). The overall pass rate was 50%. The mean score for the task-specific checklist was found to be 3.33 0.41 with a maximum score of 7 possible. Mean time of skills completion was 9.97 0.53 minutes. The overall inter-station reliability for the OSATS was 0.55. Controlling for year of training, overall pass rates were similar between programs. Feedback from residents and faculty was universally positive. CONCLUSIONS: Developing a multiple program OSATS affords the opportunity to achieve economies of scale and draw from multiple colleagues
S108
Abstracts
Figure.
CONCLUSIONS: Laparoscopic proximal tubal division preserved ovarian function and was an optimal operation method for infertility patients with hydrosalpinges. The basal FSH values after laparoscopic proximal tubal division were comparable to those before the surgery. Supported by: None.
Wednesday, October 17, 2007 3:45 pm O-289 REPRODUCTIVE OUTCOME AFTER HYSTEROSCOPIC METROPLASTY IN WOMEN WITH PRIMARY INFERTILITY. M. Abuzeid, M. Imam, K. Sakhel, M. Mitwally, M. Ashraf, M. Diamond. Division of Reproductive Endocrinology and Infertility, Hurley Medical Center, Flint, MI; IVF Michigan PC, Rochester Hills, MI; Synergy Medical Education Alliance, Michigan State, Saginaw, MI; Division of Reproductive Endocrinology and Infertility, Wayne State University, Detroit, MI.
Vol. 88, Suppl 1, September 2007