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The impact of robotic surgical training in an obstetrics and gynecology residency training curriculum
Abstracts / Gynecologic Oncology 137 (2015) 92–179
ureters that had both high absolute fluorescence (N60 counts/pixel) and SBR (3–4). Ureteral fluorescence was maintained for the entire 60 min at the 60-μg/kg dose, with peak fluorescence between 30 and 40 min. Urine fluorescence was inversely related to plasma fluorescence. Ex vivo imaging of the kidney, ureter, bladder, and abdominal wall tissues revealed low-level autofluorescence only. Conclusions: This animal study demonstrates that NIR fluorescence imaging may represent a substantial opportunity for noninvasive, intraoperative identification of the ureter. The combination of IRDye800CW-CA with an FDA-approved laparoscopic device lends substantial clinical application to gynecologic surgery and has the potential to substantially decrease the incidence of a serious urologic complications related to pelvic surgery.
doi:10.1016/j.ygyno.2015.01.324
322 - Poster Session The effect of gynecologic oncology training on surgical outcomes of radical hysterectomy N.A. Latif, R.A. Burger, M.A. Morgan, E.M. Ko. University of Pennsylvania, Philadelphia, PA, USA Objectives: To evaluate the effect of gynecologic resident and gynecologic oncology fellow participation on surgical outcomes of radical hysterectomies (RH). Methods: We evaluated all RH using a prospectively collected national database (National Surgical Quality Improvement Program [NSQIP]) from 2007 to 2012. The presence of and the highest level of a trainee in the operating room as well as patients' demographics, comorbidities, preoperative laboratory values, type of surgical approach (open abdominal vs. minimally invasive), operative time, postoperative complications, and hospital length stay were recorded. Surgical complexity was characterized by the performance of other gynecologic oncology procedures and the presence of concurrent nongynecologic (urologic, gastrointestinal) surgery. Surgical cases were categorized into three cohorts: 1) no trainee, 2) resident only, and 3) fellow present. T-test, chi square test, and univariate and multivariate regression models were used. Results: A total of 1334 RH were performed, for which 649 (49%) contained data on surgical trainee involvement: 167 (26%) cases had no trainee, 333 (51%) had residents only, and 147 (23%) had fellow participation. There were no differences in patient characteristics, preoperative laboratory values, surgical complexity, blood transfusion, complication rates, or total hospital length of stay across the three cohorts. After controlling for age, body mass index, American Society of Anesthesiologists class, open vs. minimally invasive surgery, and surgical complexity, the presence of a resident trainee was associated with 2.3 (95% CI 1.53–3.48, P = 0.005) times the likelihood of performing open abdominal RH and the presence of a fellow with 2.1 (95% CI 1.28–3.31, P = 0.003) times the likelihood. Operative time was also significantly longer with resident and fellow participation (+64 min [95% CI 49–80] and +84 min [95% CI 66– 102], P b 0.001 respectively). Conclusions: Controlling for surgical complexity, the presence of surgical trainees was significantly associated with the modality of RH; patients were more than two times as likely to undergo an open abdominal procedure and have prolonged operative times. Standardized surgical curricula, simulator training, and objective assessments should be incorporated into gynecologic oncology training to improve these surgical outcomes.
doi:10.1016/j.ygyno.2015.01.325
131
323 - Poster Session The impact of robotic surgical training in an obstetrics and gynecology residency training curriculum M. Renza, E.C. Libermanb, Y.S. Kuob, G.L. Goldbergb, N.S. Nevadunskyb. a Marine Biological Laboratory, Woods Hole, MA, USA, bAlbert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA Objectives: Resident opinions regarding robotic surgical training as part of the formal obstetrics and gynecology curriculum have not been reported. The purpose of this study was to evaluate the residents' perceived impact of robotic surgical training. Methods: After institutional review board approval, all residents who participated in a “Robotic Olympics”, which consisted of a teambased simulation competition, completed a de-identified survey of their experience and impressions of the impact of robotic surgery on their surgical training. Results: For the 27 residents who completed the event and survey, the mean number of robotic cases in which they participated was eight per resident (range, 0–50) and cases in which console time was given was four per resident (range, 0–30). Of the 31 potential future career goals, the distribution was generalist (22%), maternal fetal medicine (29%), urogynecology (19%), gynecologic oncology (16%), reproductive endocrinology (6%), and minimally invasive surgery (6%). Residents reported that they most enjoyed open surgery (60%), laparoscopic surgery (22%), vaginal surgery (7%), robotic surgery (4%), and undecided (4%). Eighty-nine percent of residents felt that they were best trained in open surgery and 40% anticipated using robotic surgery in their future practice. Of note, none of the participants interested in maternal fetal medicine compared with 53% interested in all other fields anticipated using robotic surgery in their future clinical practice (P b 0.01). Eleven percent of residents responded that robotic training negatively affected their surgical experience. The average score from 0–10 for interest in robotic surgical training was 7, and the average score from 0–10 for their comfort level with robotic surgery was 1.6. The most commonly reported barriers to robotic surgical training were as follows: lack of console time (62%), inaccessibility of the robotic simulator (19%), and not knowing how to use the simulator (19%). Conclusions: Residents' disparate opinions on the use of the robot in their futures were associated with their subspecialty goals. The scores reflect the need for directed robotic surgical training. Residents interested in surgical subspecialties should be identified early to focus their training. Incorporation of frequent “Robotic Olympics” into the resident training core curriculum may help address the most common barriers to robotic surgical training. doi:10.1016/j.ygyno.2015.01.326
324 — Poster Session Outcomes of robotic secondary cytoreductive surgery for recurrent ovarian carcinoma J.P. Diaza, A.E. Garcia-Sotob, M. Barriosc, E.D. Schroedera, R.A. Estapea, K. Lopeza, R.E. Estaped. aSouth Miami Gynecologic Oncology Group, Miami, FL, USA, bUniversity of Miami Jackson Memorial Hospital, Miami, FL, USA, cUniversity of Miami School of Medicine, Miami, FL, USA, dSouth Miami Hospital, Miami, FL, USA Objectives: To evaluate surgical and survival outcomes in patients with recurrent ovarian cancer undergoing robotic secondary cytoreduction. Methods: All patients with recurrent ovarian cancer undergoing robotic secondary cytoreduction between January 2007 and April 2014 at a single institution were included in this retrospective review. Clinicopathologic and perioperative data were analyzed. Complete cytoreduction was defined as no gross residual disease and optimal as
ureters that had both high absolute fluorescence (N60 counts/pixel) and SBR (3–4). Ureteral fluorescence was maintained for the entire 60 min at the 60-μg/kg dose, with peak fluorescence between 30 and 40 min. Urine fluorescence was inversely related to plasma fluorescence. Ex vivo imaging of the kidney, ureter, bladder, and abdominal wall tissues revealed low-level autofluorescence only. Conclusions: This animal study demonstrates that NIR fluorescence imaging may represent a substantial opportunity for noninvasive, intraoperative identification of the ureter. The combination of IRDye800CW-CA with an FDA-approved laparoscopic device lends substantial clinical application to gynecologic surgery and has the potential to substantially decrease the incidence of a serious urologic complications related to pelvic surgery.
doi:10.1016/j.ygyno.2015.01.324
322 - Poster Session The effect of gynecologic oncology training on surgical outcomes of radical hysterectomy N.A. Latif, R.A. Burger, M.A. Morgan, E.M. Ko. University of Pennsylvania, Philadelphia, PA, USA Objectives: To evaluate the effect of gynecologic resident and gynecologic oncology fellow participation on surgical outcomes of radical hysterectomies (RH). Methods: We evaluated all RH using a prospectively collected national database (National Surgical Quality Improvement Program [NSQIP]) from 2007 to 2012. The presence of and the highest level of a trainee in the operating room as well as patients' demographics, comorbidities, preoperative laboratory values, type of surgical approach (open abdominal vs. minimally invasive), operative time, postoperative complications, and hospital length stay were recorded. Surgical complexity was characterized by the performance of other gynecologic oncology procedures and the presence of concurrent nongynecologic (urologic, gastrointestinal) surgery. Surgical cases were categorized into three cohorts: 1) no trainee, 2) resident only, and 3) fellow present. T-test, chi square test, and univariate and multivariate regression models were used. Results: A total of 1334 RH were performed, for which 649 (49%) contained data on surgical trainee involvement: 167 (26%) cases had no trainee, 333 (51%) had residents only, and 147 (23%) had fellow participation. There were no differences in patient characteristics, preoperative laboratory values, surgical complexity, blood transfusion, complication rates, or total hospital length of stay across the three cohorts. After controlling for age, body mass index, American Society of Anesthesiologists class, open vs. minimally invasive surgery, and surgical complexity, the presence of a resident trainee was associated with 2.3 (95% CI 1.53–3.48, P = 0.005) times the likelihood of performing open abdominal RH and the presence of a fellow with 2.1 (95% CI 1.28–3.31, P = 0.003) times the likelihood. Operative time was also significantly longer with resident and fellow participation (+64 min [95% CI 49–80] and +84 min [95% CI 66– 102], P b 0.001 respectively). Conclusions: Controlling for surgical complexity, the presence of surgical trainees was significantly associated with the modality of RH; patients were more than two times as likely to undergo an open abdominal procedure and have prolonged operative times. Standardized surgical curricula, simulator training, and objective assessments should be incorporated into gynecologic oncology training to improve these surgical outcomes.
doi:10.1016/j.ygyno.2015.01.325
131
323 - Poster Session The impact of robotic surgical training in an obstetrics and gynecology residency training curriculum M. Renza, E.C. Libermanb, Y.S. Kuob, G.L. Goldbergb, N.S. Nevadunskyb. a Marine Biological Laboratory, Woods Hole, MA, USA, bAlbert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA Objectives: Resident opinions regarding robotic surgical training as part of the formal obstetrics and gynecology curriculum have not been reported. The purpose of this study was to evaluate the residents' perceived impact of robotic surgical training. Methods: After institutional review board approval, all residents who participated in a “Robotic Olympics”, which consisted of a teambased simulation competition, completed a de-identified survey of their experience and impressions of the impact of robotic surgery on their surgical training. Results: For the 27 residents who completed the event and survey, the mean number of robotic cases in which they participated was eight per resident (range, 0–50) and cases in which console time was given was four per resident (range, 0–30). Of the 31 potential future career goals, the distribution was generalist (22%), maternal fetal medicine (29%), urogynecology (19%), gynecologic oncology (16%), reproductive endocrinology (6%), and minimally invasive surgery (6%). Residents reported that they most enjoyed open surgery (60%), laparoscopic surgery (22%), vaginal surgery (7%), robotic surgery (4%), and undecided (4%). Eighty-nine percent of residents felt that they were best trained in open surgery and 40% anticipated using robotic surgery in their future practice. Of note, none of the participants interested in maternal fetal medicine compared with 53% interested in all other fields anticipated using robotic surgery in their future clinical practice (P b 0.01). Eleven percent of residents responded that robotic training negatively affected their surgical experience. The average score from 0–10 for interest in robotic surgical training was 7, and the average score from 0–10 for their comfort level with robotic surgery was 1.6. The most commonly reported barriers to robotic surgical training were as follows: lack of console time (62%), inaccessibility of the robotic simulator (19%), and not knowing how to use the simulator (19%). Conclusions: Residents' disparate opinions on the use of the robot in their futures were associated with their subspecialty goals. The scores reflect the need for directed robotic surgical training. Residents interested in surgical subspecialties should be identified early to focus their training. Incorporation of frequent “Robotic Olympics” into the resident training core curriculum may help address the most common barriers to robotic surgical training. doi:10.1016/j.ygyno.2015.01.326
324 — Poster Session Outcomes of robotic secondary cytoreductive surgery for recurrent ovarian carcinoma J.P. Diaza, A.E. Garcia-Sotob, M. Barriosc, E.D. Schroedera, R.A. Estapea, K. Lopeza, R.E. Estaped. aSouth Miami Gynecologic Oncology Group, Miami, FL, USA, bUniversity of Miami Jackson Memorial Hospital, Miami, FL, USA, cUniversity of Miami School of Medicine, Miami, FL, USA, dSouth Miami Hospital, Miami, FL, USA Objectives: To evaluate surgical and survival outcomes in patients with recurrent ovarian cancer undergoing robotic secondary cytoreduction. Methods: All patients with recurrent ovarian cancer undergoing robotic secondary cytoreduction between January 2007 and April 2014 at a single institution were included in this retrospective review. Clinicopathologic and perioperative data were analyzed. Complete cytoreduction was defined as no gross residual disease and optimal as