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O506 Laparoscopic ovarian drilling as a treatment option for patients with PCOS
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
promote the cross-cultural exchange of clinical and technical expertise while learning about the public health, legal and service delivery aspects of family planning, abortion and reproductive health in developing countries. Materials and Methods: Between 1993 and 2009, 87 FPFs have spent from two to eight weeks in developing countries in Asia, Africa, the Middle East and Latin America. FPFs have contributed to the delivery of clinical services, research and training projects in hospitals, clinics and universities in 33 countries. Placements are coordinated through Fellowship professional contacts and institutional resources. Results: During their placements, FPFs have made accomplishments in international family planning. Achievements include the Vietnamese translation and distribution of 30,000 copies of A Pocket Guide to Managing Contraception, training community leaders about STIs, condom use and negotiation skills in a refugee camp in Rwanda and teaching Zambian medical students about emergency contraception and management of incomplete abortions. FPFs conducted research on the use of contraception among Afghan couples and the efficacy of misoprostol for second trimester induction terminations in Uzbekistan. They introduced new clinical techniques in contraception and pregnancy termination, including the use of manual vacuum aspiration and long acting reversible contraception, in low resource settings. Conclusions: International exchange encourages the introduction of new family planning technologies into low resource settings and enhances training of those methods. O506 Laparoscopic ovarian drilling as a treatment option for patients with PCOS I. Larbah1 , M. Suwan1 , Z. El-Taie2 . 1 Misurata Central Hospital, 2 National Cancer Institute Aim: Is to find out the effectiveness of Laparoscopic Ovarian drilling in patients clinically & radiologically diagnosed as Polycystic Ovarian Syndrome (PCOS) that have long term primary or secondary infertility. Setting: At the Infertility Unit – Department of Obstetrics & Gynaecology – Misurata Central Hospital/Misurata and Department of Obstetrics & Gynaecology – Alhekma Hospital/Misurata. Mode and Methods: This is a prospective study to find out the fertility outcome in patients diagnosed as PCOS with primary or secondary infertility that underwent laparoscopic Ovarian drilling, procedure was discussed with the couple and consent was taken. 126 patients were included in the study, diagnosis of PCOS was made using the American Association of Infertility criteria for PCOS [Amenorrhea or Oligomenorrhea, signs of hyperandroginism and radiological finding of PCO by Transvaginal Sonography (TVS)]. Study ran during the period from 1st. of June 2007 to 31st. of May 2008, all cases were followed up by the study doctors up to delivery and post partum. Results: 1. 126 patients were included in the study, 68 (54%) conceived after a long period of infertility that ranged from 3 to 15 years. 2. Most patients conceived with in the first three months after the procedure. 3. There were no significant antenatal complications apart from one spontaneous miscarriage and one ectopic pregnancy. 4. C/S rate was high in those who delivered. 5. Delivered babies were good and healthy. Conclusion: In this study Laparoscopic Ovarian drilling gave good fertility rates for patients with PCOS suffering from infertility, most of the patients received treatment for ovulation induction many times prior the drilling.
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O507 Impact of virtual reality training in laparoscopic gynaecology C. Larsen1 , J. Soerensen2 , T. Grantcharov3 , T. Dalsgaard4 , L. Schouenborg4 , C. Ottosen4 , T. Schroeder5 , B. Ottesen4 . 1 Department of Gynecology 4221, The Juliane Marie Centre for Children, Women and Reproduction (JMC), Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark, 2 Department of Obstetrics 4221, JMC, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 OE, Copenhagen Denmark, 3 Division of General Surgery, St. Michael’s Hospital 30 Bond St. 16CC-056, Toronto, ON, M5W 1W8, Canada, 4 Department of Gynecology and Obstetrics 4232, JMC, Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark, 5 Department of Vascular Surgery, 3111, The Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 OE, Copenhagen, Denmark Introduction: Laparoscopic surgery is associated with longer operation time and a higher surgical complications rate during the early part of the learning curve. This has been verified in many different specialities e.g. general-, urological-, paediatric and gynaecological surgery. Compared to open surgery, laparoscopic surgery possesses distinct features making learning a challenge on several levels. The primary obstacles in learning laparoscopy are of psychomotor and perceptual nature. Virtual Reality Simulator training might be the solution to this educational challenge, how ever evidence of simulator training effect is yet sparse. Aim: The aim of the study was to establish (quantify) the possible effect of Virtual Reality Simulator training in laparoscopic gynaecology, by rigours scientific methods. Material and Methods: In a prospective observer blinded randomised controlled trial (RCT) we investigated the effect of proficiency based training in the Virtual Reality Simulator LapSimGyn procedural salpingectomy module. Subjects: 24 novice trainee gynaecologists were randomised to either simulator training or traditional clinical education. Intervention: The simulator group had repetitive training in the LapSimGyn until they reached the expert performance level determined in a previous validation study of the simulator. Control: Traditional clinical education defined as apprenticeship training and supervision and assistance by senior colleagues. Outcome: Operative performance in a human laparoscopic salpingectomy, measured as time and total score on a task specific rating scale previously validated in a separate study. Video recordings from the operations were evaluated by to independent experts blinded to subject and group status. Results: The simulator trained group performed in average 10 points better (33±2.5vs. 24±1.8 points, p < 0.0001) on the procedure specific rating scale, meaning that the performance in the simulator group was improved to a level equivalent to intermediate experienced gynaecologists (Defined as experience from 20–60 laparoscopic operations) The time taken to perform the salpingectomy was diminished with 50% (24±4.8 vs. 12±3.2 minutes) in the simulator trained group (p < 0.0001). Conclusion: Proficiency based Virtual Reality simulator training improves novice basic skills needed for laparoscopic gynaecology tremendously. Simulator training ought to be integrated into the postgraduate curriculum for specialist training in gynaecology. It could also be considered that trainees should have to pass a proficiency based training course before performing laparoscopic surgery on humans.
promote the cross-cultural exchange of clinical and technical expertise while learning about the public health, legal and service delivery aspects of family planning, abortion and reproductive health in developing countries. Materials and Methods: Between 1993 and 2009, 87 FPFs have spent from two to eight weeks in developing countries in Asia, Africa, the Middle East and Latin America. FPFs have contributed to the delivery of clinical services, research and training projects in hospitals, clinics and universities in 33 countries. Placements are coordinated through Fellowship professional contacts and institutional resources. Results: During their placements, FPFs have made accomplishments in international family planning. Achievements include the Vietnamese translation and distribution of 30,000 copies of A Pocket Guide to Managing Contraception, training community leaders about STIs, condom use and negotiation skills in a refugee camp in Rwanda and teaching Zambian medical students about emergency contraception and management of incomplete abortions. FPFs conducted research on the use of contraception among Afghan couples and the efficacy of misoprostol for second trimester induction terminations in Uzbekistan. They introduced new clinical techniques in contraception and pregnancy termination, including the use of manual vacuum aspiration and long acting reversible contraception, in low resource settings. Conclusions: International exchange encourages the introduction of new family planning technologies into low resource settings and enhances training of those methods. O506 Laparoscopic ovarian drilling as a treatment option for patients with PCOS I. Larbah1 , M. Suwan1 , Z. El-Taie2 . 1 Misurata Central Hospital, 2 National Cancer Institute Aim: Is to find out the effectiveness of Laparoscopic Ovarian drilling in patients clinically & radiologically diagnosed as Polycystic Ovarian Syndrome (PCOS) that have long term primary or secondary infertility. Setting: At the Infertility Unit – Department of Obstetrics & Gynaecology – Misurata Central Hospital/Misurata and Department of Obstetrics & Gynaecology – Alhekma Hospital/Misurata. Mode and Methods: This is a prospective study to find out the fertility outcome in patients diagnosed as PCOS with primary or secondary infertility that underwent laparoscopic Ovarian drilling, procedure was discussed with the couple and consent was taken. 126 patients were included in the study, diagnosis of PCOS was made using the American Association of Infertility criteria for PCOS [Amenorrhea or Oligomenorrhea, signs of hyperandroginism and radiological finding of PCO by Transvaginal Sonography (TVS)]. Study ran during the period from 1st. of June 2007 to 31st. of May 2008, all cases were followed up by the study doctors up to delivery and post partum. Results: 1. 126 patients were included in the study, 68 (54%) conceived after a long period of infertility that ranged from 3 to 15 years. 2. Most patients conceived with in the first three months after the procedure. 3. There were no significant antenatal complications apart from one spontaneous miscarriage and one ectopic pregnancy. 4. C/S rate was high in those who delivered. 5. Delivered babies were good and healthy. Conclusion: In this study Laparoscopic Ovarian drilling gave good fertility rates for patients with PCOS suffering from infertility, most of the patients received treatment for ovulation induction many times prior the drilling.
S237
O507 Impact of virtual reality training in laparoscopic gynaecology C. Larsen1 , J. Soerensen2 , T. Grantcharov3 , T. Dalsgaard4 , L. Schouenborg4 , C. Ottosen4 , T. Schroeder5 , B. Ottesen4 . 1 Department of Gynecology 4221, The Juliane Marie Centre for Children, Women and Reproduction (JMC), Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark, 2 Department of Obstetrics 4221, JMC, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 OE, Copenhagen Denmark, 3 Division of General Surgery, St. Michael’s Hospital 30 Bond St. 16CC-056, Toronto, ON, M5W 1W8, Canada, 4 Department of Gynecology and Obstetrics 4232, JMC, Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark, 5 Department of Vascular Surgery, 3111, The Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 OE, Copenhagen, Denmark Introduction: Laparoscopic surgery is associated with longer operation time and a higher surgical complications rate during the early part of the learning curve. This has been verified in many different specialities e.g. general-, urological-, paediatric and gynaecological surgery. Compared to open surgery, laparoscopic surgery possesses distinct features making learning a challenge on several levels. The primary obstacles in learning laparoscopy are of psychomotor and perceptual nature. Virtual Reality Simulator training might be the solution to this educational challenge, how ever evidence of simulator training effect is yet sparse. Aim: The aim of the study was to establish (quantify) the possible effect of Virtual Reality Simulator training in laparoscopic gynaecology, by rigours scientific methods. Material and Methods: In a prospective observer blinded randomised controlled trial (RCT) we investigated the effect of proficiency based training in the Virtual Reality Simulator LapSimGyn procedural salpingectomy module. Subjects: 24 novice trainee gynaecologists were randomised to either simulator training or traditional clinical education. Intervention: The simulator group had repetitive training in the LapSimGyn until they reached the expert performance level determined in a previous validation study of the simulator. Control: Traditional clinical education defined as apprenticeship training and supervision and assistance by senior colleagues. Outcome: Operative performance in a human laparoscopic salpingectomy, measured as time and total score on a task specific rating scale previously validated in a separate study. Video recordings from the operations were evaluated by to independent experts blinded to subject and group status. Results: The simulator trained group performed in average 10 points better (33±2.5vs. 24±1.8 points, p < 0.0001) on the procedure specific rating scale, meaning that the performance in the simulator group was improved to a level equivalent to intermediate experienced gynaecologists (Defined as experience from 20–60 laparoscopic operations) The time taken to perform the salpingectomy was diminished with 50% (24±4.8 vs. 12±3.2 minutes) in the simulator trained group (p < 0.0001). Conclusion: Proficiency based Virtual Reality simulator training improves novice basic skills needed for laparoscopic gynaecology tremendously. Simulator training ought to be integrated into the postgraduate curriculum for specialist training in gynaecology. It could also be considered that trainees should have to pass a proficiency based training course before performing laparoscopic surgery on humans.