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The Impact of a Five Week Minimally Invasive Gynecologic Surgery Immersion Experience on Resident Performance on Laparoscopic Task Trainers
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S71–S122
289
Open Communications 17dLaparoscopy (3:56 PM d 4:01 PM)
The Impact of a Five Week Minimally Invasive Gynecologic Surgery Immersion Experience on Resident Performance on Laparoscopic Task Trainers Vazquez M, Brotherton J. Obstetrics & Gynecology, Harbor-UCLA Medical Center, Torrance, California Study Objective: To determine if a 5 week intensive rotation focused on Minimally Invasive Gynecologic Surgery (MIGS) will increase the performance, including speed and accuracy, of third and fourth year Ob/ Gyn residents on laparoscopic trainers. Design: Retrospective Comparative Study. Setting: A county teaching hospital and a high volume Minimally Invasive Gynecologic Surgery (MIGS) practice. Patients: Nineteen Obstetrics and Gynecology residents and 5 attending MIGS surgeons. Intervention: Nine subjects were tested for speed and accuracy on 6 laparoscopic drills at 3 separate time intervals: one month prior to the MIGS rotation, within one month after the rotation, and 3 months post rotation. Five master surgeons and 10 novice surgeons were tested once to serve as controls. The number of laparoscopic procedures completed as primary surgeon prior to testing and during the 5 week intensive rotation for each subject was recorded. Subject data was analyzed to measure: the validity of the trainer tasks, subject improvement and retention over time, and if the subjects’ surgical volume influenced trainer performance. Measurements and Main Results: Three tests (Bead Transfer Task, Rubber Band Placement Task, and Suture Task) were statistically significant (p \0.050) when comparing the Novices to the Masters. Subjects’ performance improved significantly on 3 tests (Bead Transfer Task, Rubber Band Placement Task, and Suture Task) both immediately after their immersion experience as well as 3 months after the immersion experience. Volume of surgeries completed by the subjects had no statistical significance on their performance on the laparoscopic tasks. Conclusion: A 5 week intensive rotation focused on MIGS does indeed increase the performance of the third and fourth postgraduate year residents on laparoscopic trainers. The Bead Transfer Task, Rubber Band Placement Task, and Suture Task are valid tests and show statistical significance when assessing subject performance speed.
290
Open Communications 17dLaparoscopy (4:02 PM d 4:07 PM)
Reoperative Endometriosis: Histopathologic Changes as a Function of Time Brill H, Rodgers W, Seckin T, Panagopoulos G, Poynor E, Rafael O. Obstetrics and Gynecology, Lenox Hill Hospital, New York, New York Study Objective: Identify the histological changes in endometriotic lesions over time. Design: Retrospective study. Setting: An urban tertiary care teaching hospital.
S97
Patients: Thirty seven patients with previously excised endometriosis underwent a laparoscopic reexploration by the same surgeon from 1997 to 2011. Intervention: Retrospective review of surgical specimens and clinical charts. The extent and type of endometriotic lesions was classified by a gynecologic pathologist, blinded to the clinical presentation. Comparison of pathology specimens and associated fragments from the two surgeries was carried out with the Wilcoxon Signed Ranks Test. Measurements and Main Results: Patients’ median age was 33 (22 47). Pain was the primary indication for reoperation in 96%. A total of 604 specimens and 1724 tissue fragments were analyzed. Median number of confirmed endometriosis specimens and fragments in the original surgery was 3.87 (0 – 11) and 5 (0 - 40), respectively. Fibrosis was noted in 5 fragments per case (0 – 49). Second surgery analysis revealed endometriosis in median of 1 specimen (0 – 16) and 2 fragments (0 – 25). Comparison of ratios of endometriosisconfirmed fragments and specimens (p = 0.004 and p = 0.001, respectively), fragments with fibrosis (p = 0.037) revealed a significant decrease across the board. The presence of hemosiderin and foreign body giant cell reaction was not significantly different between two groups (p = 0.349). Conclusion: Our results demonstrate a statistically significant decrease in the degree of fibrosis as well as the number of specimens and fragments positive for endometriosis in reoperative cases. This study provides preliminary observations of histopathologic changes in a group of patients who underwent reexploration for endometriosis. 291
Open Communications 17dLaparoscopy (4:08 PM d 4:13 PM)
Rectovaginal Endometriosis (RVE): Evaluation of the Success and Safety of Surgery Using the Harmonic Scalpel Ramphal SR, Mchunu M. Obstetrics and Gynaecology, Endoscopic Unit, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa Study Objective: To evaluate the success and safety of surgery using the harmonic scalpel in patients with RVE. Design: Retrospective review of women who underwent surgery for RVE using the harmonic scalpel from 2005-2010. Patients were analyzed with respect to presenting complaints and perioperative complications. Follow up was to a minimum of 3 months. Setting: Tertiary referral centre. Patients: 33 consecutive patients with histological confirmation of RVE. Intervention: All patients underwent a full bowel preparation. The shaving technique for removal of the RVE was performed using the harmonic scalpel. Patients were evaluated with regard to their symptoms and were asked to compare symptoms associated with pain before and after surgery at the 3 month visit. Peri-operative complication data was collected from the patients notes. Measurements and Main Results: The mean age was 35 years(21-48), mean BMI was 27(18-34), most were nulliparous (n = 14:42.4%). The majority were Asians (n = 30: 90.9%). Thirteen patients had previous surgery for endometriosis. The most common presenting symptom was chronic pelvic pain, occurring in all. Painful defecation was reported in 12 patients. The mean operating time was 88 minutes and 28 (84.8%) had nodules >2cm. There were no thermal injuries, postoperative pyrexia, wound infection, delayed bowel leaks or fistula and no ureteric injuries. One patient required conversion to laparotomy for a bowel injury, another had repeat laparoscopy 6 hours later because of intraperitoneal bleeding from the hilum of the ovary following cystectomy. A third patient was anuric for 21 hours following surgery which involved extensive enterolysis. Imaging revealed no extravasation of urine and tapering of ureters. Bilateral double J stents were inserted and the patient subsequently passed copious amount of urine. All were managed successfully. Twenty-five (75.8%) patients reported improvement of the chronic pelvic pain after surgery. Seven of the 12 patients with painful defecation showed improvement. Conclusion: Harmonic scalpel is safe and is associated with minimum complications.
289
Open Communications 17dLaparoscopy (3:56 PM d 4:01 PM)
The Impact of a Five Week Minimally Invasive Gynecologic Surgery Immersion Experience on Resident Performance on Laparoscopic Task Trainers Vazquez M, Brotherton J. Obstetrics & Gynecology, Harbor-UCLA Medical Center, Torrance, California Study Objective: To determine if a 5 week intensive rotation focused on Minimally Invasive Gynecologic Surgery (MIGS) will increase the performance, including speed and accuracy, of third and fourth year Ob/ Gyn residents on laparoscopic trainers. Design: Retrospective Comparative Study. Setting: A county teaching hospital and a high volume Minimally Invasive Gynecologic Surgery (MIGS) practice. Patients: Nineteen Obstetrics and Gynecology residents and 5 attending MIGS surgeons. Intervention: Nine subjects were tested for speed and accuracy on 6 laparoscopic drills at 3 separate time intervals: one month prior to the MIGS rotation, within one month after the rotation, and 3 months post rotation. Five master surgeons and 10 novice surgeons were tested once to serve as controls. The number of laparoscopic procedures completed as primary surgeon prior to testing and during the 5 week intensive rotation for each subject was recorded. Subject data was analyzed to measure: the validity of the trainer tasks, subject improvement and retention over time, and if the subjects’ surgical volume influenced trainer performance. Measurements and Main Results: Three tests (Bead Transfer Task, Rubber Band Placement Task, and Suture Task) were statistically significant (p \0.050) when comparing the Novices to the Masters. Subjects’ performance improved significantly on 3 tests (Bead Transfer Task, Rubber Band Placement Task, and Suture Task) both immediately after their immersion experience as well as 3 months after the immersion experience. Volume of surgeries completed by the subjects had no statistical significance on their performance on the laparoscopic tasks. Conclusion: A 5 week intensive rotation focused on MIGS does indeed increase the performance of the third and fourth postgraduate year residents on laparoscopic trainers. The Bead Transfer Task, Rubber Band Placement Task, and Suture Task are valid tests and show statistical significance when assessing subject performance speed.
290
Open Communications 17dLaparoscopy (4:02 PM d 4:07 PM)
Reoperative Endometriosis: Histopathologic Changes as a Function of Time Brill H, Rodgers W, Seckin T, Panagopoulos G, Poynor E, Rafael O. Obstetrics and Gynecology, Lenox Hill Hospital, New York, New York Study Objective: Identify the histological changes in endometriotic lesions over time. Design: Retrospective study. Setting: An urban tertiary care teaching hospital.
S97
Patients: Thirty seven patients with previously excised endometriosis underwent a laparoscopic reexploration by the same surgeon from 1997 to 2011. Intervention: Retrospective review of surgical specimens and clinical charts. The extent and type of endometriotic lesions was classified by a gynecologic pathologist, blinded to the clinical presentation. Comparison of pathology specimens and associated fragments from the two surgeries was carried out with the Wilcoxon Signed Ranks Test. Measurements and Main Results: Patients’ median age was 33 (22 47). Pain was the primary indication for reoperation in 96%. A total of 604 specimens and 1724 tissue fragments were analyzed. Median number of confirmed endometriosis specimens and fragments in the original surgery was 3.87 (0 – 11) and 5 (0 - 40), respectively. Fibrosis was noted in 5 fragments per case (0 – 49). Second surgery analysis revealed endometriosis in median of 1 specimen (0 – 16) and 2 fragments (0 – 25). Comparison of ratios of endometriosisconfirmed fragments and specimens (p = 0.004 and p = 0.001, respectively), fragments with fibrosis (p = 0.037) revealed a significant decrease across the board. The presence of hemosiderin and foreign body giant cell reaction was not significantly different between two groups (p = 0.349). Conclusion: Our results demonstrate a statistically significant decrease in the degree of fibrosis as well as the number of specimens and fragments positive for endometriosis in reoperative cases. This study provides preliminary observations of histopathologic changes in a group of patients who underwent reexploration for endometriosis. 291
Open Communications 17dLaparoscopy (4:08 PM d 4:13 PM)
Rectovaginal Endometriosis (RVE): Evaluation of the Success and Safety of Surgery Using the Harmonic Scalpel Ramphal SR, Mchunu M. Obstetrics and Gynaecology, Endoscopic Unit, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa Study Objective: To evaluate the success and safety of surgery using the harmonic scalpel in patients with RVE. Design: Retrospective review of women who underwent surgery for RVE using the harmonic scalpel from 2005-2010. Patients were analyzed with respect to presenting complaints and perioperative complications. Follow up was to a minimum of 3 months. Setting: Tertiary referral centre. Patients: 33 consecutive patients with histological confirmation of RVE. Intervention: All patients underwent a full bowel preparation. The shaving technique for removal of the RVE was performed using the harmonic scalpel. Patients were evaluated with regard to their symptoms and were asked to compare symptoms associated with pain before and after surgery at the 3 month visit. Peri-operative complication data was collected from the patients notes. Measurements and Main Results: The mean age was 35 years(21-48), mean BMI was 27(18-34), most were nulliparous (n = 14:42.4%). The majority were Asians (n = 30: 90.9%). Thirteen patients had previous surgery for endometriosis. The most common presenting symptom was chronic pelvic pain, occurring in all. Painful defecation was reported in 12 patients. The mean operating time was 88 minutes and 28 (84.8%) had nodules >2cm. There were no thermal injuries, postoperative pyrexia, wound infection, delayed bowel leaks or fistula and no ureteric injuries. One patient required conversion to laparotomy for a bowel injury, another had repeat laparoscopy 6 hours later because of intraperitoneal bleeding from the hilum of the ovary following cystectomy. A third patient was anuric for 21 hours following surgery which involved extensive enterolysis. Imaging revealed no extravasation of urine and tapering of ureters. Bilateral double J stents were inserted and the patient subsequently passed copious amount of urine. All were managed successfully. Twenty-five (75.8%) patients reported improvement of the chronic pelvic pain after surgery. Seven of the 12 patients with painful defecation showed improvement. Conclusion: Harmonic scalpel is safe and is associated with minimum complications.