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National Welsh Survey on Laparoscopic Entry Techniques. Did the RCOG's Guidance Improve Laparoscopic Techniques in Gynaecology?
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Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S69–S89
Study Objective: To study the objective improvement in Laparoscopic Surgical Skills utilising a new laparoscopic simulator that can be used outside the hospital or laboratory environment. The improvement was measured objectively following a prescribed program over a 6 month period. Design: An observational study of surgical trainees attending a laparoscopic surgical skills course. All candidates had a variety of metrics assessed on the Haptica augmented reality simulator prior to the commencement of the course. Following a 6 month course of monthly assesment and practical skill acquisition the candidates were assesed again using the baseline assesment methodology. Setting: The study was conducted in a tertiary referral teaching hospital with a dedicated surgical skills teaching centre. All the candidates attended on a monthly basis and were taught increasingly complex tasks. Each trainee had a laparoscopic surgical skills simulator at home on which they practiced. Intervention: A total of 16 trainees with prior laparoscopic surgical exposure were assesed. The initial assesments were performend on a PC driven objective VR simulator. The metrics examined were Time (object positioning, locating/coordinating, and tissue manipulation) and Path Length (object positioning, locating/coordinating and tissue manipulation). All trainees were given their own laparoscopic simulator
ascertain the preferred entry techniques and the level of adherence to the recommended methodology. Design: A national survey of Consultants and trainees in Wales was designed to determine the preferred and alternative entry techniques and to assess their methodology of entry and port insertion against the RCOG guidelines. Setting: The survey was forwarded to 95 Consultants and 65 trainees in Wales, United Kingdom. Measurements and Main Results: 66.3% of Consultants and 56.9% trainees are responded.95% of Consultants and all the trainees reported that they had read the RCOG Laparoscopic entry guideline.In an unscarred abdomen, the most common entry method is Veress needle insufflation with closed trocar entry (73% consultants & 92% Trainees). Hasson is the preferred alternative entry technique in 49% consultants and 59.5% of registrars. Followed by Palmer s point: 9.5% vs 16%. The survey assessed the participants actual methodology and their views on whether the recommended steps of each technique are important such as: vertical intra-umbilical incision, vertical needle entry, Palmers/gas test, ports insertion and removal under vision.Insufflation pressure of 2025mm was used by 71% of Consultants and 80% of trainees. Conclusion: Our survey was able to delineate the current Laparoscopic entry practices of gynaecologists, which were consistent across Wales. Despite 95% of consultants reporting familiarity with the recent RCOG guideline, it appears that clinical practice does not necessarily coincide with current recommendations. If patients safety is to be improved further practical educational initiatives are urgently needed to ensure adherence to the recommended methodology, rather than mere terminology, of Laparoscopic entry techniques.Teaching videos (real + animation) may go further towards demonstrating the recommended methodology of each technique.
240
Open Communications 14dEndoscopic Minimally Invasive Surgery (3:03 PM d 3:08 PM)
Laparoscopic Treatment of Uterine Retroversion Associated with Pelvic Pain: Results of 22 Cases Nassif J, Gabriel B, Barata S, Wattiez A. Gynecology, IRCAD/EITS, Strasbourg, Bas Rhin, France
for home use (figure 1). They were seen monthly and new skills were taught. At the end of the 6 month period the initial metrics were re-tested. Measurements and Main Results: A total of candidateds completed the 6 month program and both the baseline assesment and the final test. There was significant improvement in all metrics measured. Conclusion: A laparoscopic surgical skills simulator used in the ‘home’ enviroment will improve objectively measured skill metrics. This study was carried out with trainees with prior laparoscopic surgery exposure.
239
Open Communications 14dEndoscopic Minimally Invasive Surgery (2:57 PM d 3:02 PM)
National Welsh Survey on Laparoscopic Entry Techniques. Did the RCOG’s Guidance Improve Laparoscopic Techniques in Gynaecology? Moukarram H, Reddy KC, Abudelmageid A. Obstetrics & Gynaecology, Royal Gwent Hospital, Newport, Wales, United Kingdom Study Objective: Following a recent guidance by the Royal College of Obstetricians and Gynaecologists (RCOG) on Laparoscopic entry we performed a national survey among the gynaecologists in Wales to
Study Objective: Evaluate clinical outcome after laparoscopic anterior ligamentopexy for retroverted uterus associated with pelvic pain. Design: Prospective study, duration of the study is 36 months, mean follow up is 19 months. Setting: Strasbourg University Hospitals and IRCAD/EITS. Patients: We found the association of chronic pelvic pain, retroverted uterus, pain relief with ventral decubitus and no other obvious etiologies for pelvic pain in many patients presenting to our department. 22 patients presented the four criteria and were enrolled in this study. Intervention: Intraoperative correction of uterine retroversion by pulling ventrally on the round ligaments is first done. The change of uterus’color from purple to pink-red is required so that laparoscopic anterior ligamentopexy is performed. Two inscisions of 1.5 cm are done in each iliac fossa. The rectal aponeurosis is opened and a Kocher clamp is passed through the internal inguinal ring. The round ligaments are grasped and attached to the rectal aponeurosis with non absorbable suture. Local anaesthetics are injected under the aponeurosis and in the round ligaments at their attachments to the aponeurosis. Measurements and Main Results: Pre operative and post operative pain scores are assessed by visual analogous scale. Type and postoperative duration of use of pain killers are also noted. Fertility data and subsequent surgeries for other abdominal pathologies are collected. Results are still ongoing. Conclusion: Preliminary result analysis show good results for pain control after laparoscopic anterior ligamentopexy. Since pelvic pain associated with uterine retroversion is still a challenging and controversial pathology to diagnose and treat, randomised controlled study are mandatory.
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S69–S89
Study Objective: To study the objective improvement in Laparoscopic Surgical Skills utilising a new laparoscopic simulator that can be used outside the hospital or laboratory environment. The improvement was measured objectively following a prescribed program over a 6 month period. Design: An observational study of surgical trainees attending a laparoscopic surgical skills course. All candidates had a variety of metrics assessed on the Haptica augmented reality simulator prior to the commencement of the course. Following a 6 month course of monthly assesment and practical skill acquisition the candidates were assesed again using the baseline assesment methodology. Setting: The study was conducted in a tertiary referral teaching hospital with a dedicated surgical skills teaching centre. All the candidates attended on a monthly basis and were taught increasingly complex tasks. Each trainee had a laparoscopic surgical skills simulator at home on which they practiced. Intervention: A total of 16 trainees with prior laparoscopic surgical exposure were assesed. The initial assesments were performend on a PC driven objective VR simulator. The metrics examined were Time (object positioning, locating/coordinating, and tissue manipulation) and Path Length (object positioning, locating/coordinating and tissue manipulation). All trainees were given their own laparoscopic simulator
ascertain the preferred entry techniques and the level of adherence to the recommended methodology. Design: A national survey of Consultants and trainees in Wales was designed to determine the preferred and alternative entry techniques and to assess their methodology of entry and port insertion against the RCOG guidelines. Setting: The survey was forwarded to 95 Consultants and 65 trainees in Wales, United Kingdom. Measurements and Main Results: 66.3% of Consultants and 56.9% trainees are responded.95% of Consultants and all the trainees reported that they had read the RCOG Laparoscopic entry guideline.In an unscarred abdomen, the most common entry method is Veress needle insufflation with closed trocar entry (73% consultants & 92% Trainees). Hasson is the preferred alternative entry technique in 49% consultants and 59.5% of registrars. Followed by Palmer s point: 9.5% vs 16%. The survey assessed the participants actual methodology and their views on whether the recommended steps of each technique are important such as: vertical intra-umbilical incision, vertical needle entry, Palmers/gas test, ports insertion and removal under vision.Insufflation pressure of 2025mm was used by 71% of Consultants and 80% of trainees. Conclusion: Our survey was able to delineate the current Laparoscopic entry practices of gynaecologists, which were consistent across Wales. Despite 95% of consultants reporting familiarity with the recent RCOG guideline, it appears that clinical practice does not necessarily coincide with current recommendations. If patients safety is to be improved further practical educational initiatives are urgently needed to ensure adherence to the recommended methodology, rather than mere terminology, of Laparoscopic entry techniques.Teaching videos (real + animation) may go further towards demonstrating the recommended methodology of each technique.
240
Open Communications 14dEndoscopic Minimally Invasive Surgery (3:03 PM d 3:08 PM)
Laparoscopic Treatment of Uterine Retroversion Associated with Pelvic Pain: Results of 22 Cases Nassif J, Gabriel B, Barata S, Wattiez A. Gynecology, IRCAD/EITS, Strasbourg, Bas Rhin, France
for home use (figure 1). They were seen monthly and new skills were taught. At the end of the 6 month period the initial metrics were re-tested. Measurements and Main Results: A total of candidateds completed the 6 month program and both the baseline assesment and the final test. There was significant improvement in all metrics measured. Conclusion: A laparoscopic surgical skills simulator used in the ‘home’ enviroment will improve objectively measured skill metrics. This study was carried out with trainees with prior laparoscopic surgery exposure.
239
Open Communications 14dEndoscopic Minimally Invasive Surgery (2:57 PM d 3:02 PM)
National Welsh Survey on Laparoscopic Entry Techniques. Did the RCOG’s Guidance Improve Laparoscopic Techniques in Gynaecology? Moukarram H, Reddy KC, Abudelmageid A. Obstetrics & Gynaecology, Royal Gwent Hospital, Newport, Wales, United Kingdom Study Objective: Following a recent guidance by the Royal College of Obstetricians and Gynaecologists (RCOG) on Laparoscopic entry we performed a national survey among the gynaecologists in Wales to
Study Objective: Evaluate clinical outcome after laparoscopic anterior ligamentopexy for retroverted uterus associated with pelvic pain. Design: Prospective study, duration of the study is 36 months, mean follow up is 19 months. Setting: Strasbourg University Hospitals and IRCAD/EITS. Patients: We found the association of chronic pelvic pain, retroverted uterus, pain relief with ventral decubitus and no other obvious etiologies for pelvic pain in many patients presenting to our department. 22 patients presented the four criteria and were enrolled in this study. Intervention: Intraoperative correction of uterine retroversion by pulling ventrally on the round ligaments is first done. The change of uterus’color from purple to pink-red is required so that laparoscopic anterior ligamentopexy is performed. Two inscisions of 1.5 cm are done in each iliac fossa. The rectal aponeurosis is opened and a Kocher clamp is passed through the internal inguinal ring. The round ligaments are grasped and attached to the rectal aponeurosis with non absorbable suture. Local anaesthetics are injected under the aponeurosis and in the round ligaments at their attachments to the aponeurosis. Measurements and Main Results: Pre operative and post operative pain scores are assessed by visual analogous scale. Type and postoperative duration of use of pain killers are also noted. Fertility data and subsequent surgeries for other abdominal pathologies are collected. Results are still ongoing. Conclusion: Preliminary result analysis show good results for pain control after laparoscopic anterior ligamentopexy. Since pelvic pain associated with uterine retroversion is still a challenging and controversial pathology to diagnose and treat, randomised controlled study are mandatory.