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Simulator Training Combined with Structured Supervision Improve Laparoscopic Performance for Residents in Obstetrics and Gynecology
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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S91–S113
underwent laparoscopy were much less likely to have a complication than those who underwent abdominal hysterectomy (OR 0.37, 95%CI 0.1480.927). Patient characteristics and indications were examined. Patients who underwent hysterectomy for endometriosis were much more likely to have a complication (OR 5.25, 95%CI 1.1-24.9) than other indications. Conclusion: In our cohort, laparoscopic hysterectomy had the fewest postoperative complications. Patients who underwent hysterectomy for endometriosis were much more likely to have a post-operative complication than patients with other benign indications.
365
Open Communications 18dLaparoscopy (9:48 AM d 9:53 AM)
Simulator Training Combined with Structured Supervision Improve Laparoscopic Performance for Residents in Obstetrics and Gynecology Ahlborg L, Nisell H, Rasmussen C, Enochsson L. Dep of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Study Objective: To investigate if residents in Obstetrics and Gynecology improve their result when performing laparoscopic tubal occlusion, following simulator training and structured mentorship. Design: 28 residents in Obstetrics and Gynecology were enrolled and randomized into three groups. The first group trained in a simulator to a certain validated level, the second group trained likewise in the simulator and additionally received structured mentorship and the third group got neither. A baseline tubal occlusion was performed prior to simulator training. Operation time was measured at baseline and in the tubal occlusions following simulator training. One of the simulator groups additionally received structured mentorship, according to checklists, before and after surgery. Setting: The residents were from 21 different hospitals in Sweden. Recorded operations were done at their respective clinics. Simulator training took place at the Center for Advanced Medical Simulation, Karolinska University Hospital, Stockholm, Sweden, during two days. Measurements and Main Results: At baseline, the three groups exhibited a similar performance level with regard to time spent. The two groups, which received simulator training, performed subsequent operations, in significantly shorter time (392 96 s, mean SEM) than the control group, (867 114 s, p\0.05). The group receiving structured supervision had the shortest time, although not significantly different from the other simulator group. Conclusion: Structured simulator training and mentorship appear to improve operating time for novices performing laparoscopic tubal occlusion. This simulator training program and the mentor checklists could be included in training programs for residents in Obstetric and Gynecology.
366
Open Communications 18dLaparoscopy (9:54 AM d 9:59 AM)
Pelvic Nerve Damage Secondary to Surgery for Pelvic Organ Prolapse – Risk Procedures, Symptoms and Management – Report of 92 Cases Possover MMP,1 Lemos NNL.2 1Neuropelveology & Advanced Surgical Gynecology, Hirslanden Clinic, Zuerich, Switzerland; 2Gynecology, Federal University S~ ao Paolo, S~ao Paolo, Brazil Study Objective: To report about pelvic nerves damages secondary to surgical treatment of pelvic organ prolapse, and the role of laparoscopy at the diagnosis and treatment such nerve damages. Design: Prospective cohort study. Setting: Tertiary referral advanced laparoscopic gynecology and neuropelveologic unit.
Patients: Ninety-five consecutive patients complaining of pain and/or bladder/bowel dysfunction after surgery for pelvic prolapse underwent laparoscopic exploration for pelvic neuropathy. Intervention: Etiologic treatments included not only removal of sutures or mesh-material but also different neurosurgical techniques done by laparoscopy, such as nerve-decompression, neurolysis, deafferentation or a laparoscopic implantation of neuroprothesis to injured nerves for postoperative neuromodulation. Measurements and Main Results: Mean VAS-score reduction from 8,9 (0,96; 6-10) preoperatively to 2,9 (2,77; 0-6) at one-year follow-up was obtained in patients after laparoscopic nerve decompression (n = 90) (p\ 0,001); two patients were treated successfully as well for bladder dysfunction by sacral plexus neuromodulation. Conclusion: Because secondary nerve damages can appear months or years after the primary procedure, long term follow up is mandatory, not only focused anatomical and functional outcomes but also on nerve damage. Laparoscopy is then a unique method for etiologic diagnosis and neurosurgical treatment of such nerve lesions, by means of decompression or implantation of electrode for neuromodulation.
367
Video Session 11dLaparoscopy (8:00 AM d 8:07 AM)
Laparoscopic Management of Juvenile Cystic Adenomyoma – A Rare Cause of Dysmenorrhea Kriplani A, Mahey R, Agarwal N, Bhatla N. Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India Five cases of juvenile cystic adenomyoma presenting with severe dysmenorrhea during a period of two years are reported. All patients underwent laparoscopy due to failed symptomatic relief from medical management. Preoperative diagnosis in all patients was noncommunicating uterine horn with hematometra or degenerated myoma. Intraoperatively all cases had juvenile cystic adenomyoma (JCA) separate from uterine cavity. Resection of lesion was done completely in single sitting. Histopathology revealed features of adenomyosis in all cases. Patients are asymptomatic on a minimum follow up of 12 months. This case series emphasizes the possibility of cystic adenomyosis in refractory cases of persistent primary or secondary dysmenorrhea in young adolescents. So these patients should be evaluated carefully and low threshold should be kept for surgical resection of the lesion
368
Video Session 11dLaparoscopy (8:08 AM d 8:16 AM)
Vaginal Morcellation Using SEMM Set Lee E-J, Semm I, Kim DH. Obstetrics and Gynecology, Chung-Ang University School of Medicine, Seoul, Korea A limit of laparoscopic approach is to remove the large surgical specimens. The introduction of electomechanical morcellation reduced the procedure time, but still morcellation is the most time-consuming part of the entire procedure. Bigger morcellator is preferred to avoid prolongation of operation time, but additional skin incision, causing more pain and less cosmetic effect, does not correspond to the requirements of minimally invasive surgery. Therefore, we carried out morcellation by the vaginal route using by SEMM morcellation set. Hereby, we showed how to perform the vaginal morcellation in the cases of the myomectomy and subtotal hysterectomy. From the result of our experiences, vaginal morcellation is safe and effective and is more cosmetic because of no additional skin incision. Moreover, larger sized morcellator can be applied to save the procedure time in the cases of huge mass. Thus, vaginal morcellation could be an easy way to strengthen the laparoscopic operation.
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S91–S113
underwent laparoscopy were much less likely to have a complication than those who underwent abdominal hysterectomy (OR 0.37, 95%CI 0.1480.927). Patient characteristics and indications were examined. Patients who underwent hysterectomy for endometriosis were much more likely to have a complication (OR 5.25, 95%CI 1.1-24.9) than other indications. Conclusion: In our cohort, laparoscopic hysterectomy had the fewest postoperative complications. Patients who underwent hysterectomy for endometriosis were much more likely to have a post-operative complication than patients with other benign indications.
365
Open Communications 18dLaparoscopy (9:48 AM d 9:53 AM)
Simulator Training Combined with Structured Supervision Improve Laparoscopic Performance for Residents in Obstetrics and Gynecology Ahlborg L, Nisell H, Rasmussen C, Enochsson L. Dep of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Study Objective: To investigate if residents in Obstetrics and Gynecology improve their result when performing laparoscopic tubal occlusion, following simulator training and structured mentorship. Design: 28 residents in Obstetrics and Gynecology were enrolled and randomized into three groups. The first group trained in a simulator to a certain validated level, the second group trained likewise in the simulator and additionally received structured mentorship and the third group got neither. A baseline tubal occlusion was performed prior to simulator training. Operation time was measured at baseline and in the tubal occlusions following simulator training. One of the simulator groups additionally received structured mentorship, according to checklists, before and after surgery. Setting: The residents were from 21 different hospitals in Sweden. Recorded operations were done at their respective clinics. Simulator training took place at the Center for Advanced Medical Simulation, Karolinska University Hospital, Stockholm, Sweden, during two days. Measurements and Main Results: At baseline, the three groups exhibited a similar performance level with regard to time spent. The two groups, which received simulator training, performed subsequent operations, in significantly shorter time (392 96 s, mean SEM) than the control group, (867 114 s, p\0.05). The group receiving structured supervision had the shortest time, although not significantly different from the other simulator group. Conclusion: Structured simulator training and mentorship appear to improve operating time for novices performing laparoscopic tubal occlusion. This simulator training program and the mentor checklists could be included in training programs for residents in Obstetric and Gynecology.
366
Open Communications 18dLaparoscopy (9:54 AM d 9:59 AM)
Pelvic Nerve Damage Secondary to Surgery for Pelvic Organ Prolapse – Risk Procedures, Symptoms and Management – Report of 92 Cases Possover MMP,1 Lemos NNL.2 1Neuropelveology & Advanced Surgical Gynecology, Hirslanden Clinic, Zuerich, Switzerland; 2Gynecology, Federal University S~ ao Paolo, S~ao Paolo, Brazil Study Objective: To report about pelvic nerves damages secondary to surgical treatment of pelvic organ prolapse, and the role of laparoscopy at the diagnosis and treatment such nerve damages. Design: Prospective cohort study. Setting: Tertiary referral advanced laparoscopic gynecology and neuropelveologic unit.
Patients: Ninety-five consecutive patients complaining of pain and/or bladder/bowel dysfunction after surgery for pelvic prolapse underwent laparoscopic exploration for pelvic neuropathy. Intervention: Etiologic treatments included not only removal of sutures or mesh-material but also different neurosurgical techniques done by laparoscopy, such as nerve-decompression, neurolysis, deafferentation or a laparoscopic implantation of neuroprothesis to injured nerves for postoperative neuromodulation. Measurements and Main Results: Mean VAS-score reduction from 8,9 (0,96; 6-10) preoperatively to 2,9 (2,77; 0-6) at one-year follow-up was obtained in patients after laparoscopic nerve decompression (n = 90) (p\ 0,001); two patients were treated successfully as well for bladder dysfunction by sacral plexus neuromodulation. Conclusion: Because secondary nerve damages can appear months or years after the primary procedure, long term follow up is mandatory, not only focused anatomical and functional outcomes but also on nerve damage. Laparoscopy is then a unique method for etiologic diagnosis and neurosurgical treatment of such nerve lesions, by means of decompression or implantation of electrode for neuromodulation.
367
Video Session 11dLaparoscopy (8:00 AM d 8:07 AM)
Laparoscopic Management of Juvenile Cystic Adenomyoma – A Rare Cause of Dysmenorrhea Kriplani A, Mahey R, Agarwal N, Bhatla N. Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India Five cases of juvenile cystic adenomyoma presenting with severe dysmenorrhea during a period of two years are reported. All patients underwent laparoscopy due to failed symptomatic relief from medical management. Preoperative diagnosis in all patients was noncommunicating uterine horn with hematometra or degenerated myoma. Intraoperatively all cases had juvenile cystic adenomyoma (JCA) separate from uterine cavity. Resection of lesion was done completely in single sitting. Histopathology revealed features of adenomyosis in all cases. Patients are asymptomatic on a minimum follow up of 12 months. This case series emphasizes the possibility of cystic adenomyosis in refractory cases of persistent primary or secondary dysmenorrhea in young adolescents. So these patients should be evaluated carefully and low threshold should be kept for surgical resection of the lesion
368
Video Session 11dLaparoscopy (8:08 AM d 8:16 AM)
Vaginal Morcellation Using SEMM Set Lee E-J, Semm I, Kim DH. Obstetrics and Gynecology, Chung-Ang University School of Medicine, Seoul, Korea A limit of laparoscopic approach is to remove the large surgical specimens. The introduction of electomechanical morcellation reduced the procedure time, but still morcellation is the most time-consuming part of the entire procedure. Bigger morcellator is preferred to avoid prolongation of operation time, but additional skin incision, causing more pain and less cosmetic effect, does not correspond to the requirements of minimally invasive surgery. Therefore, we carried out morcellation by the vaginal route using by SEMM morcellation set. Hereby, we showed how to perform the vaginal morcellation in the cases of the myomectomy and subtotal hysterectomy. From the result of our experiences, vaginal morcellation is safe and effective and is more cosmetic because of no additional skin incision. Moreover, larger sized morcellator can be applied to save the procedure time in the cases of huge mass. Thus, vaginal morcellation could be an easy way to strengthen the laparoscopic operation.