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Perspectives on Preparedness for AAGL Fellowship in Minimally Invasive Gynecology: A Quantitative Assessment of Program Directors and First-Year Fellows
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Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
551 Laparoscopic Burch Colposuspension: Elevating Routine Treatment Options for Complex Patients Jorgensen EM,1 Azodi M,1 Hammons L.2 1Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; 2Minimally Invasive & Robotic Surgery, Bridgeport Hospital, Bridgeport, Connecticut Laparoscopic Burch colposuspension is an effective treatment for stress urinary incontinence (SUI) in complex patients. Here, we review surgical technique and anatomy, and discuss several advantages of the Burch over standard midurethral slings. We propose enhancing classic Burch colposuspension by placing an additional lateral suture, increasing support in patients with suboptimal tissue. Three sutures bilaterally suspend a larger portion of the bladder neck, maximizing elevation of the urethra. The Burch is an excellent option for patients who are not candidates for slings, as it avoids mesh, can be used in poor tissue (from prior surgery, infection, radiation or chemotherapy), and paravaginal defects can be repaired concurrently using the same dissection. The Burch is an alternative for patients wishing to avoid mesh or autologous fascial harvest. Because it is such a powerful tool, Burch colposuspension should remain in the armamentarium of the modern gynecologic surgeon caring for complex patients with SUI.
clinical evaluation/management, and 5) academia/scholarship. Responses were reported using a five-point Likert scale. Differences in perceptions of preparedness were compared using Wilcoxon Rank Sum and Fisher Exact tests. Measurements and Main Results: Response rates were 66% (26/39) and 62% (26/42) for F1s and PDs respectively. Significant differences between PD and F1 responses were most frequent in the surgical independence and clinical evaluation/management domains (7/9 and 10/10 queries respectively). This included perceptions of F1 ability to independently perform basic laparoscopic and robotic hysterectomies. Participants agreed F1s demonstrated patient ownership (81% vs 92%, p=0.42). However, PDs were less likely to believe the F1 could independently and safely perform 30 minutes of a gynecologic procedure (62% vs 96%, p\0.005). PDs were also less likely to agree that F1s would recognize features of critically ill patients (73% vs 96%, p\0.05). PDs and F1s agreed F1s had genuine interest in academic projects (81% vs 65%, p=0.35), but PDs were less likely to agree that F1s had a basic understanding of statistics (65% vs 35%, p=0.05). Conclusion: PDs and F1s demonstrated key differences in perceptions of the fellows’ preparedness for FMIGS training across all domains. Perceptions were most discordant in surgical independence and clinical evaluation/management domains. Understanding these differences may offer insight into focused areas of improvement in AAGL FMIGS programs. 554
552 Laparoscopic Native Tissue Repair of the Posterior Compartment Noe GK. Ob/Gyn, Comunal Clinic of Dormagen, Dormagen, NRW, Germany The posterior compartment defect is traditionally treated by vaginal route. This requires opening the vaginal mucosa and leads to a central scar. Fascia and Mucosa is separated and the access to the upper third of the vaginal wall is difficult to identify especially the definition of structures like bowel and ureter is problematic. For the treatment of rectocele and enterocele we have developed a laparoscopic approach. The peritoneum is opened in the pouch of Douglas and the recto-vaginal septum is opened. The preparation follows an avascular space up to the anus. A running suture forms a new ceiling and enables a thickening of the vaginal wall by gathering the facial tissue. The fascia is sutured by an absorbable, mono-filamental suture 2-0. The laparoscopic access provides a perfect view at all structures. This allows the facial suturing at the whole length of the posterior vaginal wall. Virtual Posters – Basic Science/Research/Education 553 Perspectives on Preparedness for AAGL Fellowship in Minimally Invasive Gynecology: A Quantitative Assessment of Program Directors and First-Year Fellows Dave A, Yi J. Mayo Clinic, Phoenix, Arizona Study Objective: Assess differences in perceptions of preparedness for AAGL Fellowship in Minimally Invasive Gynecology (FMIGS) between AAGL Program Directors (PD) and First-year Fellows (F1). Design: Anonymous electronic survey (Google Forms, Mountain View, CA). Setting: National survey. Patients: AAGL FMIGS PDs and F1s. Intervention: Participants completed surveys about their perceptions of F1s readiness for fellowship training. The survey instrument was developed by the Fellowship Council, modified with permission, and sent through AAGLmaintained listservs. Five domains of preparedness were assessed: 1) professionalism, 2) level of independence in clinical and surgical settings, 3) psychomotor ability, 4)
Development of Low Fidelity Trainer to Teach Residents Total Vaginal Hysterectomy Braun KM, Henley B, Ray CB, Stager RD, Rungruang BJ. Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia Study Objective: Decline in hysterectomies and provider comfort have led to decreased exposure to total vaginal hysterectomy (TVH) during residency training. Our goal was to develop an inexpensive, low fidelity TVH trainer that could be used by Ob-Gyn residents when performing simulation for TVH. Design: Pilot design of a novel low fidelity vaginal hysterectomy trainer utilized during residency simulation training to teach TVH. Setting: The model is manipulated with traditional surgical instruments and suture during dedicated simulation session. Patients: Ob-Gyn residents at a single academic center. Intervention: A complete low fidelity vaginal hysterectomy trainer was constructed using common items; the model was adapted from previously published models to include vulva and more realistic-feeling materials. Items used included: ‘‘pelvic base’’- flower pot and board; ‘‘vulva’’- pink foam cowboy hat (figure 1); uterine model insert (figure 2) (suspended
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
551 Laparoscopic Burch Colposuspension: Elevating Routine Treatment Options for Complex Patients Jorgensen EM,1 Azodi M,1 Hammons L.2 1Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; 2Minimally Invasive & Robotic Surgery, Bridgeport Hospital, Bridgeport, Connecticut Laparoscopic Burch colposuspension is an effective treatment for stress urinary incontinence (SUI) in complex patients. Here, we review surgical technique and anatomy, and discuss several advantages of the Burch over standard midurethral slings. We propose enhancing classic Burch colposuspension by placing an additional lateral suture, increasing support in patients with suboptimal tissue. Three sutures bilaterally suspend a larger portion of the bladder neck, maximizing elevation of the urethra. The Burch is an excellent option for patients who are not candidates for slings, as it avoids mesh, can be used in poor tissue (from prior surgery, infection, radiation or chemotherapy), and paravaginal defects can be repaired concurrently using the same dissection. The Burch is an alternative for patients wishing to avoid mesh or autologous fascial harvest. Because it is such a powerful tool, Burch colposuspension should remain in the armamentarium of the modern gynecologic surgeon caring for complex patients with SUI.
clinical evaluation/management, and 5) academia/scholarship. Responses were reported using a five-point Likert scale. Differences in perceptions of preparedness were compared using Wilcoxon Rank Sum and Fisher Exact tests. Measurements and Main Results: Response rates were 66% (26/39) and 62% (26/42) for F1s and PDs respectively. Significant differences between PD and F1 responses were most frequent in the surgical independence and clinical evaluation/management domains (7/9 and 10/10 queries respectively). This included perceptions of F1 ability to independently perform basic laparoscopic and robotic hysterectomies. Participants agreed F1s demonstrated patient ownership (81% vs 92%, p=0.42). However, PDs were less likely to believe the F1 could independently and safely perform 30 minutes of a gynecologic procedure (62% vs 96%, p\0.005). PDs were also less likely to agree that F1s would recognize features of critically ill patients (73% vs 96%, p\0.05). PDs and F1s agreed F1s had genuine interest in academic projects (81% vs 65%, p=0.35), but PDs were less likely to agree that F1s had a basic understanding of statistics (65% vs 35%, p=0.05). Conclusion: PDs and F1s demonstrated key differences in perceptions of the fellows’ preparedness for FMIGS training across all domains. Perceptions were most discordant in surgical independence and clinical evaluation/management domains. Understanding these differences may offer insight into focused areas of improvement in AAGL FMIGS programs. 554
552 Laparoscopic Native Tissue Repair of the Posterior Compartment Noe GK. Ob/Gyn, Comunal Clinic of Dormagen, Dormagen, NRW, Germany The posterior compartment defect is traditionally treated by vaginal route. This requires opening the vaginal mucosa and leads to a central scar. Fascia and Mucosa is separated and the access to the upper third of the vaginal wall is difficult to identify especially the definition of structures like bowel and ureter is problematic. For the treatment of rectocele and enterocele we have developed a laparoscopic approach. The peritoneum is opened in the pouch of Douglas and the recto-vaginal septum is opened. The preparation follows an avascular space up to the anus. A running suture forms a new ceiling and enables a thickening of the vaginal wall by gathering the facial tissue. The fascia is sutured by an absorbable, mono-filamental suture 2-0. The laparoscopic access provides a perfect view at all structures. This allows the facial suturing at the whole length of the posterior vaginal wall. Virtual Posters – Basic Science/Research/Education 553 Perspectives on Preparedness for AAGL Fellowship in Minimally Invasive Gynecology: A Quantitative Assessment of Program Directors and First-Year Fellows Dave A, Yi J. Mayo Clinic, Phoenix, Arizona Study Objective: Assess differences in perceptions of preparedness for AAGL Fellowship in Minimally Invasive Gynecology (FMIGS) between AAGL Program Directors (PD) and First-year Fellows (F1). Design: Anonymous electronic survey (Google Forms, Mountain View, CA). Setting: National survey. Patients: AAGL FMIGS PDs and F1s. Intervention: Participants completed surveys about their perceptions of F1s readiness for fellowship training. The survey instrument was developed by the Fellowship Council, modified with permission, and sent through AAGLmaintained listservs. Five domains of preparedness were assessed: 1) professionalism, 2) level of independence in clinical and surgical settings, 3) psychomotor ability, 4)
Development of Low Fidelity Trainer to Teach Residents Total Vaginal Hysterectomy Braun KM, Henley B, Ray CB, Stager RD, Rungruang BJ. Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia Study Objective: Decline in hysterectomies and provider comfort have led to decreased exposure to total vaginal hysterectomy (TVH) during residency training. Our goal was to develop an inexpensive, low fidelity TVH trainer that could be used by Ob-Gyn residents when performing simulation for TVH. Design: Pilot design of a novel low fidelity vaginal hysterectomy trainer utilized during residency simulation training to teach TVH. Setting: The model is manipulated with traditional surgical instruments and suture during dedicated simulation session. Patients: Ob-Gyn residents at a single academic center. Intervention: A complete low fidelity vaginal hysterectomy trainer was constructed using common items; the model was adapted from previously published models to include vulva and more realistic-feeling materials. Items used included: ‘‘pelvic base’’- flower pot and board; ‘‘vulva’’- pink foam cowboy hat (figure 1); uterine model insert (figure 2) (suspended