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Reducing abdominal incisions in gynecologic surgery
Oral Presentations
training programs. The purpose of this study was to examine current state of basic and advanced gynecologic endoscopy resident Paining in Canadian universities. Design. Program directors received a pretested questionnaire examining factors related to residency training in laparoscopy and hysteroscopy. Setting. Canadian university obstetrics and gynecology residency programs. Participants. All program directors in Canadian academic programs. Measurements and Main Results. Ninety-three percent (13/14) of program directors completed the survey. Program directors expect all residents to be knowledgeable and competent in performing basic endoscopic procedures upon graduation. There is considerable variation in programs ensuring adequate Paining in advanced procedures, such as the treatment of moderate to severe endomegiosis or laparoscopic-assisted vaginal hysterectomy (LAVH). Among the most important factors limiting integration of advanced endoscopic training include lack of gained faculty and/or financial resources. Eleven of 14 programs have a dedicated faculty member skilled in endoscopic training and mentoring. One third of programs are unable to offer after hours and weekend emergency endoscopic coverage due to lack of trained faculty. The majority of program directors think that endoscopic surgery is essential to contemporary gynecologic practice and support incorporation of new emerging procedures. Conclusion. Integration of gynecologic endoscopy in Canadian university residency programs has raised serious training issues. However, there is overall consensus and support to improve resident education in endoscopy.
125. EndoscopyTraining in Canada: Survey of Senior Obstetric and Gynecology Residents E Raymond, NA Leyland, AM Ternamian. St. Joseph's Health Center, Toronto, Ontario, Canada.
Objectives. To examine current gynecologic endoscopy training in Canadian obstetrics and gynecology residency programs. The level of self-perceived competency in advanced endoscopic procedures was evaluated, and barriers to and interest in further endoscopic training was assessed. Design. Survey. Setting. Canadian university obstetrics and gynecology residency programs. Participants. All final year (PGY5) obstetrics and gynecology residents. Intervention. Final year residents received a mailed questionnaire to survey their self-perceived competency in laparoscopic and hysteroscopic procedures, the level of training they received, and their interest in further training in endoscopy. Measurements andMain Results. More than three quarters of final year residents completed the survey (40/52). Most residents felt that the emphasis on endoscopy should be increased and half felt their program did not prepare them to perform advanced endoscopic procedures. While
50% of programs offer a formal curriculum with didactic lectures, dry and wet laboratory training, only 19% offer a formal surgical skills assessment before graduation. Consequently, 15% to 35% of final year residents continue to be uncomfortable performing basic laparoscopic procedures. Residents described shortages of gained faculty, lack of attending interest, and scarcity of operating time/financial resources as important barriers to endoscopic Paining. The majority of residents consider a fellowship in gynecologic endoscopy important and support recruiting of faculty skilled in minimally invasive surgery. Conclusion. Graduating residents think that endoscopy is essential to their future practice, however, many do not think they are competent performing basic and advanced procedures upon graduation. Canadian obstetrics and gynecology programs need to address these important training issues in minimally invasive surgery to better prepare future practitioners and insure patient safety.
126. Reducing Abdominal Incisions in Gynecologic Surgery DA Tsin. The Mount Sinai Hospital of Queens, Jackson Heights, New York.
Study Objective. To present a program for the reduction by up to 50% in the abdominal incision size used in gynecologic surgery. Design. A pilot program in minimally invasive gynecologic surgery. Setting. The Mount Sinai Hospital of Queens. Measurements and Main Results. The program and techniques were presented to members of the gynecology staff at continuing medical education dedicated conferences. I also provided a mentorship program. I used the following elements: to change from laparotomy to minilaparotomy, I used the elastic retractor technique (Mobius); in laparoscopy, 10-mm scopes were changed to 5-mm scopes. I also taught minilaparoscopy and culdolaparoscopy, a technique that combines minilaparoscopy with operative culdoscopy. Minilaparotomy was relatively easy and fast to teach and produced the best results: more than 90% of laparotomies were changed to minilaparotomies. Minilaparotomy was used for hysterectomies, myomectomies, ovarian cystectomies, oophorectomies, supracervical hysterectomies, tuboplasties, and sacropromontory fixations. Regarding laparoscopy, changing from 10-mm to 5-mm laparoscopes was easier, but only reduced the incision size by 5 mm. Whereas the implementation of minilaparoscopy and culdolaparoscopy appeared most promising, they were more difficult to teach and only few subsequently used the techniques. Conclusion. Reduction by up to 50% in the abdominal incision size was achieved at the end of a 1-year program. Changing laparotomy to minilaparotomy was relatively easy, less expensive and a major overall factor in our success. Culdolaparoscopy and advanced endoscopic procedures provided the smallest abdominal incision size per case.
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training programs. The purpose of this study was to examine current state of basic and advanced gynecologic endoscopy resident Paining in Canadian universities. Design. Program directors received a pretested questionnaire examining factors related to residency training in laparoscopy and hysteroscopy. Setting. Canadian university obstetrics and gynecology residency programs. Participants. All program directors in Canadian academic programs. Measurements and Main Results. Ninety-three percent (13/14) of program directors completed the survey. Program directors expect all residents to be knowledgeable and competent in performing basic endoscopic procedures upon graduation. There is considerable variation in programs ensuring adequate Paining in advanced procedures, such as the treatment of moderate to severe endomegiosis or laparoscopic-assisted vaginal hysterectomy (LAVH). Among the most important factors limiting integration of advanced endoscopic training include lack of gained faculty and/or financial resources. Eleven of 14 programs have a dedicated faculty member skilled in endoscopic training and mentoring. One third of programs are unable to offer after hours and weekend emergency endoscopic coverage due to lack of trained faculty. The majority of program directors think that endoscopic surgery is essential to contemporary gynecologic practice and support incorporation of new emerging procedures. Conclusion. Integration of gynecologic endoscopy in Canadian university residency programs has raised serious training issues. However, there is overall consensus and support to improve resident education in endoscopy.
125. EndoscopyTraining in Canada: Survey of Senior Obstetric and Gynecology Residents E Raymond, NA Leyland, AM Ternamian. St. Joseph's Health Center, Toronto, Ontario, Canada.
Objectives. To examine current gynecologic endoscopy training in Canadian obstetrics and gynecology residency programs. The level of self-perceived competency in advanced endoscopic procedures was evaluated, and barriers to and interest in further endoscopic training was assessed. Design. Survey. Setting. Canadian university obstetrics and gynecology residency programs. Participants. All final year (PGY5) obstetrics and gynecology residents. Intervention. Final year residents received a mailed questionnaire to survey their self-perceived competency in laparoscopic and hysteroscopic procedures, the level of training they received, and their interest in further training in endoscopy. Measurements andMain Results. More than three quarters of final year residents completed the survey (40/52). Most residents felt that the emphasis on endoscopy should be increased and half felt their program did not prepare them to perform advanced endoscopic procedures. While
50% of programs offer a formal curriculum with didactic lectures, dry and wet laboratory training, only 19% offer a formal surgical skills assessment before graduation. Consequently, 15% to 35% of final year residents continue to be uncomfortable performing basic laparoscopic procedures. Residents described shortages of gained faculty, lack of attending interest, and scarcity of operating time/financial resources as important barriers to endoscopic Paining. The majority of residents consider a fellowship in gynecologic endoscopy important and support recruiting of faculty skilled in minimally invasive surgery. Conclusion. Graduating residents think that endoscopy is essential to their future practice, however, many do not think they are competent performing basic and advanced procedures upon graduation. Canadian obstetrics and gynecology programs need to address these important training issues in minimally invasive surgery to better prepare future practitioners and insure patient safety.
126. Reducing Abdominal Incisions in Gynecologic Surgery DA Tsin. The Mount Sinai Hospital of Queens, Jackson Heights, New York.
Study Objective. To present a program for the reduction by up to 50% in the abdominal incision size used in gynecologic surgery. Design. A pilot program in minimally invasive gynecologic surgery. Setting. The Mount Sinai Hospital of Queens. Measurements and Main Results. The program and techniques were presented to members of the gynecology staff at continuing medical education dedicated conferences. I also provided a mentorship program. I used the following elements: to change from laparotomy to minilaparotomy, I used the elastic retractor technique (Mobius); in laparoscopy, 10-mm scopes were changed to 5-mm scopes. I also taught minilaparoscopy and culdolaparoscopy, a technique that combines minilaparoscopy with operative culdoscopy. Minilaparotomy was relatively easy and fast to teach and produced the best results: more than 90% of laparotomies were changed to minilaparotomies. Minilaparotomy was used for hysterectomies, myomectomies, ovarian cystectomies, oophorectomies, supracervical hysterectomies, tuboplasties, and sacropromontory fixations. Regarding laparoscopy, changing from 10-mm to 5-mm laparoscopes was easier, but only reduced the incision size by 5 mm. Whereas the implementation of minilaparoscopy and culdolaparoscopy appeared most promising, they were more difficult to teach and only few subsequently used the techniques. Conclusion. Reduction by up to 50% in the abdominal incision size was achieved at the end of a 1-year program. Changing laparotomy to minilaparotomy was relatively easy, less expensive and a major overall factor in our success. Culdolaparoscopy and advanced endoscopic procedures provided the smallest abdominal incision size per case.
$44