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Realistic full-environment training for office-based gynecologic surgery using linked surgical and anesthesia patient simulators
Abstracts
168. Discharging Patients to Home Care Directly from Recovery Room after LAVH
3 months after surgery. Lysis was performed of thick and extensive adhesions between the rectosigmoid colon and posterior wall of the uterus and uterosacralligaments, obliterating the lower portion of the cul-desac. This was followed by myolysis with bipolar needle (J.E.M.D. Medical, Hicksville, NY) of deep infiltrating nodules of the rectovaginal septum. No vaginal perforations or rectum damage occurred. Patients were evaluated preoperatively and postoperatively for pelvic pain and extension of painful nodularities in the rectovaginal septum. After surgery, they reported moderate to complete pain relief. Clinically, we observed absence or important reduction of palpable painful nodules. Long-term follow-up is in progress to evaluate the stability of our results or the presence of persistent endometriosis. Conclusion. Treatment of rectovaginal endometriosis with of the bipolar needle seems to be promising and efficient.
NV Simon, MD Bornt, JL Musser. York Health System, York, Pennsylvania.
Objective. To see if the cost of LAVH can be safely decreased by discharging patients to home care directly from the recovery room. Measurements and Main Results. After LAVH, 63 consecutive women (age range 25-61 yrs) were discharged to home care after a 6-hour stay in the recovery room. Home care consisted of two skilled nursing home visits 12 hours apart, starting the day of thesurgery, with telephone reports to the surgeon. Review of physician office records and satisfaction surveys indicated that 13 (20.6%) women had no problem. The other 50 had a total of 55 problems during the first 3 days. These were trivial and easily treated by telephone by the visiting nurse. The most frequent concerns were bloating and gas with pain and no bowel movement (13), incision and abdominal pain (6), mild temperature (6), estrogen deprivation symptoms (4), low hematocrit or hemoblogin (3), allergic reaction (3), and concern over ecchymosis and bruising (2). Forty-four (69.8%) women returned satisfaction surveys. Ten (22.7%) preferred 1 to 2 nights in a hospital after surgery, and 8 felt unprepared and overwhelmed by the discharge process. Three women (6.8%) questioned teaching patients in the recovery room and the lateness of discharge. Conclusion. Although discharge 6 hours after LAVH is possible, it may not be in everybody's best interest, since 29.5% of patients returning surveys (20.6% of all patients) expressed serious reservations or dissatisfaction with the process.
170. Realistic Full-Environment Training for OfficeBased Gynecologic Surgery Using Linked Surgical and Anesthesia Patient Simulators SO Small, K Isaacson. Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
Objective. To describe a realistic, full-environment simulation training course for office-based gynecologic laparoscopy and hysteroscopy. Measurements and Main Results. Five videotapes show high-fidelity examples of office-based gynecologic minimally invasive procedures. The pilot course builds directly on proved aviation and derivative anesthesia crisis resource management training. Full procedure teams operate in the setting of linked simulators: a nonanimal-based surgical simulator, a full-length computerized patient mannequin, and an anesthesia simulator that accurately models pharmacology, physiology, and pathophysiology and drives actual monitor arrays. Conclusion. This surgical-anesthesia simulation and videotape debriefing will increase the relevance and power of both training and research in patient safety as well as individual and team performance in officebased procedures.
169. Laparoscopic Bipolar Needle in the Treatment of Rectovaginal Septum Endometriosis 10 Sizzi, 1A Rossetti, 1S Zulli, 1A Lanzone, 2S Mancuso. 1Columbus Hospital, Catholic University of Rome, Rome, Italy; 2Policlinico Gemelli, Rome, Italy.
Objective. To assess efficacy and safety of laparoscopic bipolar needle myolysis of deep infiltrating endometriotic nodules of the rectovaginal septum. Measurements and Main Results. Ten women with chronic pelvic pain and deep infiltrating palpable endometriotic nodules of rectovaginal septum were treated with triptoreline 375 mg for 1 month before and
$48
168. Discharging Patients to Home Care Directly from Recovery Room after LAVH
3 months after surgery. Lysis was performed of thick and extensive adhesions between the rectosigmoid colon and posterior wall of the uterus and uterosacralligaments, obliterating the lower portion of the cul-desac. This was followed by myolysis with bipolar needle (J.E.M.D. Medical, Hicksville, NY) of deep infiltrating nodules of the rectovaginal septum. No vaginal perforations or rectum damage occurred. Patients were evaluated preoperatively and postoperatively for pelvic pain and extension of painful nodularities in the rectovaginal septum. After surgery, they reported moderate to complete pain relief. Clinically, we observed absence or important reduction of palpable painful nodules. Long-term follow-up is in progress to evaluate the stability of our results or the presence of persistent endometriosis. Conclusion. Treatment of rectovaginal endometriosis with of the bipolar needle seems to be promising and efficient.
NV Simon, MD Bornt, JL Musser. York Health System, York, Pennsylvania.
Objective. To see if the cost of LAVH can be safely decreased by discharging patients to home care directly from the recovery room. Measurements and Main Results. After LAVH, 63 consecutive women (age range 25-61 yrs) were discharged to home care after a 6-hour stay in the recovery room. Home care consisted of two skilled nursing home visits 12 hours apart, starting the day of thesurgery, with telephone reports to the surgeon. Review of physician office records and satisfaction surveys indicated that 13 (20.6%) women had no problem. The other 50 had a total of 55 problems during the first 3 days. These were trivial and easily treated by telephone by the visiting nurse. The most frequent concerns were bloating and gas with pain and no bowel movement (13), incision and abdominal pain (6), mild temperature (6), estrogen deprivation symptoms (4), low hematocrit or hemoblogin (3), allergic reaction (3), and concern over ecchymosis and bruising (2). Forty-four (69.8%) women returned satisfaction surveys. Ten (22.7%) preferred 1 to 2 nights in a hospital after surgery, and 8 felt unprepared and overwhelmed by the discharge process. Three women (6.8%) questioned teaching patients in the recovery room and the lateness of discharge. Conclusion. Although discharge 6 hours after LAVH is possible, it may not be in everybody's best interest, since 29.5% of patients returning surveys (20.6% of all patients) expressed serious reservations or dissatisfaction with the process.
170. Realistic Full-Environment Training for OfficeBased Gynecologic Surgery Using Linked Surgical and Anesthesia Patient Simulators SO Small, K Isaacson. Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
Objective. To describe a realistic, full-environment simulation training course for office-based gynecologic laparoscopy and hysteroscopy. Measurements and Main Results. Five videotapes show high-fidelity examples of office-based gynecologic minimally invasive procedures. The pilot course builds directly on proved aviation and derivative anesthesia crisis resource management training. Full procedure teams operate in the setting of linked simulators: a nonanimal-based surgical simulator, a full-length computerized patient mannequin, and an anesthesia simulator that accurately models pharmacology, physiology, and pathophysiology and drives actual monitor arrays. Conclusion. This surgical-anesthesia simulation and videotape debriefing will increase the relevance and power of both training and research in patient safety as well as individual and team performance in officebased procedures.
169. Laparoscopic Bipolar Needle in the Treatment of Rectovaginal Septum Endometriosis 10 Sizzi, 1A Rossetti, 1S Zulli, 1A Lanzone, 2S Mancuso. 1Columbus Hospital, Catholic University of Rome, Rome, Italy; 2Policlinico Gemelli, Rome, Italy.
Objective. To assess efficacy and safety of laparoscopic bipolar needle myolysis of deep infiltrating endometriotic nodules of the rectovaginal septum. Measurements and Main Results. Ten women with chronic pelvic pain and deep infiltrating palpable endometriotic nodules of rectovaginal septum were treated with triptoreline 375 mg for 1 month before and
$48