- Email: [email protected]
Video Game Impact on Basic Robotic Surgical Skills
S156
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
symptomatic anterior wall and apical vaginal vault prolapse who desire surgical repair without the use of graft.
Mean (95% confidence interval) rankings (1=least helpful scenario, 10=most helpful scenario) of potential laparoscopic emergency scenarios
568 Vault Prolapse Repair Without Use of Mesh Nutan J. Vardhman Trauma and Laparoscopy Centre Pvt. Ltd., Muzaffarnagar, Uttar Pradesh, India Laparoscopic site specific management of vault prolapse. The present video hails from a tertiary care referral center for advanced laparoscopic gynecologic surgery in North India. It demonstrates the laparoscopic management of vault prolapse using the principles of sitespecific repair without the use of mesh. The procedure comprises of judicious repair of breaks in the endopelvic fascia which are readily identified laparoscopically. Anteriorly the pubocervical fascia is plicated, posteriorly the rectovaginal septum is restored to the level of ischial spine. Vault fixation is done to the proximal ends of uterosacrals at the level of pericervical ring. The hiatus through which enterocele occurs is thus buttressed anteriorly as well as posteriorly utilizing body’s own support mechanism. The surgery achieves gratifying results as shown by four year follow-up of 115 cases managed at our center with this approach. The surgery utilizes autologous tissue, hence avoids all complications associated with the use of mesh. 569 Laser Laparascopy and Excision of Bladder Endometriosis With Operative Cystoscopy Algreisi F,1 Vilos G,1 Oraif A,2 Vilos A,1 Pautler S.1 1The Fertility Clinic, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada; 2Obstetrics and Gynecology, Faculty of Medicine, King AbdulAziz University, Jeddah, Western Region, Saudi Arabia Case 22-year-old nulliparous lady presented with cyclical hematuria and suprapubic pain. she was other wise healthy. Physical examination was unremarkable. MRI showed a lesion in the bladder size 3x4 cm. She was offered laser laparascopy and resection of bladder lesion.
Virtual Posters 570
Virtual Posters – Basic Science/Research/Education
A Needs Assessment of Laparoscopic Emergency Simulation Training in Residency Programs DeStephano CC, Wells A, Dinh TA. Department of Gynecology, Mayo Clinic Florida, Jacksonville, Florida Study Objective: To assess Ob/Gyn residents’ perceptions of laparoscopic emergency simulation training in their residency programs. Design: This is an IRB approved study designed as a cross-sectional survey of residents between July 2014-January 2015. Setting: A list of program coordinators’ email addresses was obtained from the CREOG Directory of Obstetric-Gynecologic Residency Program Coordinators. The needs assessment online survey was emailed to program coordinators who were asked to forward the survey link to residents in their programs. Patients: Program coordinators at 24 accredited United States residency programs confirmed sending the online survey to the residents in their program. Out of 542 residents who were sent the survey, 111 residents completed the online survey (20.5% response rate). Intervention: Using an online survey, residents rated their participation in laparoscopic emergency simulation training. They were then asked to assess whether additional simulation training would be helpful. Measurements and Main Results: Of 89 residents who responded, 49 (55.1%) reported dedicated time is provided for gynecologic laparoscopic procedure training using pelvic trainers, virtual reality programs, and/or
Postoperative hemorrhage following laparoscopic myomectomy/hysterectomy Management of retroperitoneal hematoma resulting from uterine perforation during D&C Vessel injury repair Ruptured ectopic pregnancy Hysterectomy Bladder injury and repair Ovarian torsion Laceration of the vaginal cuff Bowel injury and repair Management of appendicitis
Mean Ranking (n=91)
(95% Confidence Interval)
6.64
6.05-7.22
6.21
5.64-6.74
6.00 5.72 5.68 5.67 5.27 4.86 4.74 4.16
5.45-6.57 5.03-6.42 4.97-6.39 5.24-6.14 4.74-5.86 4.41-5.37 4.20-5.18 3.48-4.92
Note: each rank between 1-10 could only be used once box trainers while 23 (25.8%) reported protected time using biologic specimens (cadaver or porcine labs). Only 7 (7.8%) of 90 respondents reported emergency laparoscopic scenarios are simulated at their programs while 78 (83.9%) of 93 respondents reported that simulation drills of emergency obstetric scenarios are completed (p\0.01). Of 92 respondents, 78 (84.8%) agreed or strongly agreed that there is a need for more laparoscopic emergency simulation training at their institution. Table 1 reports resident rankings of potential laparoscopic emergency scenarios. Conclusion: There is underutilization of laparoscopic emergency simulation training at the 24 United States residency programs surveyed. Residents reported a need for additional laparoscopic emergency simulation training. 571 Video Game Impact on Basic Robotic Surgical Skills Simpson K,3 Tanaka A,1 Graddy C,1 Perez M,2 Truong M,3 Smith R.1 1 Florida Hospital Nicholson Center, Celebration, Florida; 2Nancy University Hospital-Lorrain, Nancy, France; 3Obstetrics and Gynecology, Columbia University Medical Center, New York, New York Study Objective: To compare the performance of ‘‘expert’’ video gamers to medical students, ‘‘laypeople,’’ and expert robotic surgeons in a robotic surgery simulator. Design: Prospective study. Setting: Surgical training centers, medical schools, and videogame colleges. Patients: Video gamers (n=40), medical students (n=24), laypeople ((n=35) and robotic surgeons (n=6) were recruited. Intervention: Subjects completed a demographic questionnaire and three computer-based perceptual tests: a Flanker compatibility task, subsidizing task, and Multiple Object Tracking. Participants performed two warm-up exercises and eight trials of two exercises (i.e. Ring & Rail 1 and Basic Suture Sponge) on the Mimic dV-Trainer. Participants then completed the NASA Task Load Index and a post-questionnaire. Measurements and Main Results: Gamers improved significantly from trial one to trial eight for all metrics in Ring & Rail 1 (Overall Score (OS) p=0.000; Economy of Motion (EoM) p=0.000; and Time p=0.000) and Suture Sponge (OS p=0.000; EoM p=0.000; and Time p=0.000). Surgeons performed better on trial one of Ring & Rail for all metrics (OS p\0.05; EoM p\0.05; and Time p=0.002). Gamers performed significantly better than laypeople on trial eight of Ring & Rail for Economy of Motion (p\0.05) and Time (p\0.05). Surgeons performed significantly better for all metrics (OS p=0.000; EoM p\0.005; and Time p=0.00) in the first and eighth trials (OS p\0.05; EoM p=0.001; and Time p=0.000) of Suture Sponge. Medical students outperformed gamers for Time (p=0.05) in the first trial. No other differences were found.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Conclusion: A preliminary analysis indicates that videogame experience may influence the acquisition of basic, but not complex robotic surgical skills. The results could have implications for surgical training and other fields, indicating that consideration should be paid to the application of skills developed through other technologies. This study is ongoing and a final analysis will be available for presentation. 572 Trends in Obstetrics-Gynecology Subspecialization Wasson MN,1 Ashurst JV.2 1Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona; 2Emergency Medicine, Duke Lifepoint Conemaugh Memorial Medical Center, Johnstown, Pennsylvania Study Objective: To compare differences in trends of subspecialization training amongst obstetrics-gynecologists in the United States. Design: Retrospective analysis of the obstetrics-gynecology match database from the National Residency Match Program (NRMP). Setting: NRMP participating obstetrics-gynecology specialty and subspecialty programs (female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, reproductive endocrinology and infertility, pediatric and adolescent gynecology, and minimally invasive gynecology). Patients: All individuals participating in the NRMP match for obstetricsgynecology subspecialization. Measurements and Main Results: Since 2005, the number of obstetricsgynecology residency positions has increased by 8.57% (2005 n=1144; 2014 n=1242). Similarly, all obstetrics-gynecology subspecialties participating in the NRMP have increased the number of positions available. The increase was greatest among the female pelvic medicine and reconstructive surgery fellowship at 129.17% (2005 n=24; 2014 n=55) and least among the pediatric and adolescent gynecology fellowship at 16.67% (2012 n=6; 2014 n=7).
The medical training of applicants securing subspecialty training positions has changed over time. Graduates of United States allopathic medical schools had the greatest increase in number of matched positions at 52.08% (2005 n=144; 2014 n= 219), while United States citizen graduates of international medical schools had the smallest increase at 5.88% (2005 n=17; 2014 n=18).
S157
In 2014, United States allopathic medical school graduates accounted for 82.02% of all individuals matching into subspecialty training and 80.00% of applicants accepted in to obstetrics-gynecology residency. Conclusion: The overall number of general and subspecialty obstetricsgynecology positions has increased since 2005. However, the substantial increase in subspecialty training positions indicates an increased need and acceptance of subspecialization within obstetrics-gynecology. Additionally, the predominant medical training of applicants accepted into residency and subspecialty programs remains United States allopathic medical school graduates. 573 Genetic Risk Factors of Large Myomas Altukhova OB,1 Churnosov MI,2 Lebedeva OP.1 1Obstetrics and Gynecology, Belgorod State National Research University, Belgorod, Belgorod Region, Russian Federation; 2Medical Biology, Belgorod State National Research University, Belgorod, Belgorod Region, Russian Federation Study Objective: To determine genetic risk factors of large myomas. Design: Prospective cohort study. Setting: Academic affiliated community hospital and university laboratory ‘‘Human molecular genetics’’. Patients: 120 women with large myoma nodes (more than 4 cm) and 107 patients with small myoma nodes (up to 4 cm). Intervention: Samples were received by laparoscopic conservative myomectomy. Genotyping was performed using qPCR with TaqMan probes. The analysis of associations of combinations of genetic options is carried out by means of the software of APSampler using a Monte Carlo method with Markov chains and Bayesian nonparametric statistics. Measurements and Main Results: Risk factors of development of myoma nodes of the large sizes are combinations of genetic options of three polymorphic loci: regulator of activity of normal expression and secretion of T-cells (rs2107538), factor of stromal cells (rs1801157) and interleukin1b (rs16944). In group of patients with large myoma nodes the combination of genetic G SDF-1 options, CC IL-1b, A RANTES (19,81%) were found by 4,5 times more often, and A RANTES allele combination with genotype CC IL-1b by 4 times more often than in group of patients with small sizes of myoma nodes (4,30%, pf =0,0006, pperm = 0,009, and 5,15%, pf =0,001, pperm = 0,01, respectively). These combinations of genetic options of cytokines increase risk of forming of large myomatous nodes at hysteromyoma (OR=5,56 and OR=4,60, respectively). Conclusion: Thus, the obtained data testify to involvement of genetic polymorphisms of cytokines into forming of myoma nodes of the large sizes. Risk factors of their development are two combinations of genetic options: G SDF-1, CC IL-1b, A RANTES (OR=5,56) and A RANTES with genotype CC IL-1b (OR=4,60). Supported by state contract N 511/2014. 574 Development and Validation of a Structured Curriculum for Laparoscopic Supracervical Hysterectomy Goderstad JM,1 Sandvik L,2 Fosse E,2 Lieng M.2 1Gynecology, Sørlandet Hospital, Arendal, Norway; 2Oslo University Hospital, Oslo, Norway Study Objective: To develop a curriculum for laparoscopic supracervical hysterectomy and assess the effect of this curriculum on surgical performance. Estimation of the operating costs of the curriculum. Design: Prospective cohort study. Setting: Hospitals in the south region of Norway. Patients: Registrars at hospitals in the south region of Norway. The participants have previously performed less than 50 laparoscopic procedures in total, and no laparoscopic hysterectomies. Intervention: The curriculum consists of four steps. Step one is a theoretical part with a multiple – choice test. Step two is a practical part with five tasks on a simulator (Simbionix LapMentor). The study participants can practice up to 4 hours per week, an not more than 2
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
symptomatic anterior wall and apical vaginal vault prolapse who desire surgical repair without the use of graft.
Mean (95% confidence interval) rankings (1=least helpful scenario, 10=most helpful scenario) of potential laparoscopic emergency scenarios
568 Vault Prolapse Repair Without Use of Mesh Nutan J. Vardhman Trauma and Laparoscopy Centre Pvt. Ltd., Muzaffarnagar, Uttar Pradesh, India Laparoscopic site specific management of vault prolapse. The present video hails from a tertiary care referral center for advanced laparoscopic gynecologic surgery in North India. It demonstrates the laparoscopic management of vault prolapse using the principles of sitespecific repair without the use of mesh. The procedure comprises of judicious repair of breaks in the endopelvic fascia which are readily identified laparoscopically. Anteriorly the pubocervical fascia is plicated, posteriorly the rectovaginal septum is restored to the level of ischial spine. Vault fixation is done to the proximal ends of uterosacrals at the level of pericervical ring. The hiatus through which enterocele occurs is thus buttressed anteriorly as well as posteriorly utilizing body’s own support mechanism. The surgery achieves gratifying results as shown by four year follow-up of 115 cases managed at our center with this approach. The surgery utilizes autologous tissue, hence avoids all complications associated with the use of mesh. 569 Laser Laparascopy and Excision of Bladder Endometriosis With Operative Cystoscopy Algreisi F,1 Vilos G,1 Oraif A,2 Vilos A,1 Pautler S.1 1The Fertility Clinic, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada; 2Obstetrics and Gynecology, Faculty of Medicine, King AbdulAziz University, Jeddah, Western Region, Saudi Arabia Case 22-year-old nulliparous lady presented with cyclical hematuria and suprapubic pain. she was other wise healthy. Physical examination was unremarkable. MRI showed a lesion in the bladder size 3x4 cm. She was offered laser laparascopy and resection of bladder lesion.
Virtual Posters 570
Virtual Posters – Basic Science/Research/Education
A Needs Assessment of Laparoscopic Emergency Simulation Training in Residency Programs DeStephano CC, Wells A, Dinh TA. Department of Gynecology, Mayo Clinic Florida, Jacksonville, Florida Study Objective: To assess Ob/Gyn residents’ perceptions of laparoscopic emergency simulation training in their residency programs. Design: This is an IRB approved study designed as a cross-sectional survey of residents between July 2014-January 2015. Setting: A list of program coordinators’ email addresses was obtained from the CREOG Directory of Obstetric-Gynecologic Residency Program Coordinators. The needs assessment online survey was emailed to program coordinators who were asked to forward the survey link to residents in their programs. Patients: Program coordinators at 24 accredited United States residency programs confirmed sending the online survey to the residents in their program. Out of 542 residents who were sent the survey, 111 residents completed the online survey (20.5% response rate). Intervention: Using an online survey, residents rated their participation in laparoscopic emergency simulation training. They were then asked to assess whether additional simulation training would be helpful. Measurements and Main Results: Of 89 residents who responded, 49 (55.1%) reported dedicated time is provided for gynecologic laparoscopic procedure training using pelvic trainers, virtual reality programs, and/or
Postoperative hemorrhage following laparoscopic myomectomy/hysterectomy Management of retroperitoneal hematoma resulting from uterine perforation during D&C Vessel injury repair Ruptured ectopic pregnancy Hysterectomy Bladder injury and repair Ovarian torsion Laceration of the vaginal cuff Bowel injury and repair Management of appendicitis
Mean Ranking (n=91)
(95% Confidence Interval)
6.64
6.05-7.22
6.21
5.64-6.74
6.00 5.72 5.68 5.67 5.27 4.86 4.74 4.16
5.45-6.57 5.03-6.42 4.97-6.39 5.24-6.14 4.74-5.86 4.41-5.37 4.20-5.18 3.48-4.92
Note: each rank between 1-10 could only be used once box trainers while 23 (25.8%) reported protected time using biologic specimens (cadaver or porcine labs). Only 7 (7.8%) of 90 respondents reported emergency laparoscopic scenarios are simulated at their programs while 78 (83.9%) of 93 respondents reported that simulation drills of emergency obstetric scenarios are completed (p\0.01). Of 92 respondents, 78 (84.8%) agreed or strongly agreed that there is a need for more laparoscopic emergency simulation training at their institution. Table 1 reports resident rankings of potential laparoscopic emergency scenarios. Conclusion: There is underutilization of laparoscopic emergency simulation training at the 24 United States residency programs surveyed. Residents reported a need for additional laparoscopic emergency simulation training. 571 Video Game Impact on Basic Robotic Surgical Skills Simpson K,3 Tanaka A,1 Graddy C,1 Perez M,2 Truong M,3 Smith R.1 1 Florida Hospital Nicholson Center, Celebration, Florida; 2Nancy University Hospital-Lorrain, Nancy, France; 3Obstetrics and Gynecology, Columbia University Medical Center, New York, New York Study Objective: To compare the performance of ‘‘expert’’ video gamers to medical students, ‘‘laypeople,’’ and expert robotic surgeons in a robotic surgery simulator. Design: Prospective study. Setting: Surgical training centers, medical schools, and videogame colleges. Patients: Video gamers (n=40), medical students (n=24), laypeople ((n=35) and robotic surgeons (n=6) were recruited. Intervention: Subjects completed a demographic questionnaire and three computer-based perceptual tests: a Flanker compatibility task, subsidizing task, and Multiple Object Tracking. Participants performed two warm-up exercises and eight trials of two exercises (i.e. Ring & Rail 1 and Basic Suture Sponge) on the Mimic dV-Trainer. Participants then completed the NASA Task Load Index and a post-questionnaire. Measurements and Main Results: Gamers improved significantly from trial one to trial eight for all metrics in Ring & Rail 1 (Overall Score (OS) p=0.000; Economy of Motion (EoM) p=0.000; and Time p=0.000) and Suture Sponge (OS p=0.000; EoM p=0.000; and Time p=0.000). Surgeons performed better on trial one of Ring & Rail for all metrics (OS p\0.05; EoM p\0.05; and Time p=0.002). Gamers performed significantly better than laypeople on trial eight of Ring & Rail for Economy of Motion (p\0.05) and Time (p\0.05). Surgeons performed significantly better for all metrics (OS p=0.000; EoM p\0.005; and Time p=0.00) in the first and eighth trials (OS p\0.05; EoM p=0.001; and Time p=0.000) of Suture Sponge. Medical students outperformed gamers for Time (p=0.05) in the first trial. No other differences were found.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Conclusion: A preliminary analysis indicates that videogame experience may influence the acquisition of basic, but not complex robotic surgical skills. The results could have implications for surgical training and other fields, indicating that consideration should be paid to the application of skills developed through other technologies. This study is ongoing and a final analysis will be available for presentation. 572 Trends in Obstetrics-Gynecology Subspecialization Wasson MN,1 Ashurst JV.2 1Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona; 2Emergency Medicine, Duke Lifepoint Conemaugh Memorial Medical Center, Johnstown, Pennsylvania Study Objective: To compare differences in trends of subspecialization training amongst obstetrics-gynecologists in the United States. Design: Retrospective analysis of the obstetrics-gynecology match database from the National Residency Match Program (NRMP). Setting: NRMP participating obstetrics-gynecology specialty and subspecialty programs (female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, reproductive endocrinology and infertility, pediatric and adolescent gynecology, and minimally invasive gynecology). Patients: All individuals participating in the NRMP match for obstetricsgynecology subspecialization. Measurements and Main Results: Since 2005, the number of obstetricsgynecology residency positions has increased by 8.57% (2005 n=1144; 2014 n=1242). Similarly, all obstetrics-gynecology subspecialties participating in the NRMP have increased the number of positions available. The increase was greatest among the female pelvic medicine and reconstructive surgery fellowship at 129.17% (2005 n=24; 2014 n=55) and least among the pediatric and adolescent gynecology fellowship at 16.67% (2012 n=6; 2014 n=7).
The medical training of applicants securing subspecialty training positions has changed over time. Graduates of United States allopathic medical schools had the greatest increase in number of matched positions at 52.08% (2005 n=144; 2014 n= 219), while United States citizen graduates of international medical schools had the smallest increase at 5.88% (2005 n=17; 2014 n=18).
S157
In 2014, United States allopathic medical school graduates accounted for 82.02% of all individuals matching into subspecialty training and 80.00% of applicants accepted in to obstetrics-gynecology residency. Conclusion: The overall number of general and subspecialty obstetricsgynecology positions has increased since 2005. However, the substantial increase in subspecialty training positions indicates an increased need and acceptance of subspecialization within obstetrics-gynecology. Additionally, the predominant medical training of applicants accepted into residency and subspecialty programs remains United States allopathic medical school graduates. 573 Genetic Risk Factors of Large Myomas Altukhova OB,1 Churnosov MI,2 Lebedeva OP.1 1Obstetrics and Gynecology, Belgorod State National Research University, Belgorod, Belgorod Region, Russian Federation; 2Medical Biology, Belgorod State National Research University, Belgorod, Belgorod Region, Russian Federation Study Objective: To determine genetic risk factors of large myomas. Design: Prospective cohort study. Setting: Academic affiliated community hospital and university laboratory ‘‘Human molecular genetics’’. Patients: 120 women with large myoma nodes (more than 4 cm) and 107 patients with small myoma nodes (up to 4 cm). Intervention: Samples were received by laparoscopic conservative myomectomy. Genotyping was performed using qPCR with TaqMan probes. The analysis of associations of combinations of genetic options is carried out by means of the software of APSampler using a Monte Carlo method with Markov chains and Bayesian nonparametric statistics. Measurements and Main Results: Risk factors of development of myoma nodes of the large sizes are combinations of genetic options of three polymorphic loci: regulator of activity of normal expression and secretion of T-cells (rs2107538), factor of stromal cells (rs1801157) and interleukin1b (rs16944). In group of patients with large myoma nodes the combination of genetic G SDF-1 options, CC IL-1b, A RANTES (19,81%) were found by 4,5 times more often, and A RANTES allele combination with genotype CC IL-1b by 4 times more often than in group of patients with small sizes of myoma nodes (4,30%, pf =0,0006, pperm = 0,009, and 5,15%, pf =0,001, pperm = 0,01, respectively). These combinations of genetic options of cytokines increase risk of forming of large myomatous nodes at hysteromyoma (OR=5,56 and OR=4,60, respectively). Conclusion: Thus, the obtained data testify to involvement of genetic polymorphisms of cytokines into forming of myoma nodes of the large sizes. Risk factors of their development are two combinations of genetic options: G SDF-1, CC IL-1b, A RANTES (OR=5,56) and A RANTES with genotype CC IL-1b (OR=4,60). Supported by state contract N 511/2014. 574 Development and Validation of a Structured Curriculum for Laparoscopic Supracervical Hysterectomy Goderstad JM,1 Sandvik L,2 Fosse E,2 Lieng M.2 1Gynecology, Sørlandet Hospital, Arendal, Norway; 2Oslo University Hospital, Oslo, Norway Study Objective: To develop a curriculum for laparoscopic supracervical hysterectomy and assess the effect of this curriculum on surgical performance. Estimation of the operating costs of the curriculum. Design: Prospective cohort study. Setting: Hospitals in the south region of Norway. Patients: Registrars at hospitals in the south region of Norway. The participants have previously performed less than 50 laparoscopic procedures in total, and no laparoscopic hysterectomies. Intervention: The curriculum consists of four steps. Step one is a theoretical part with a multiple – choice test. Step two is a practical part with five tasks on a simulator (Simbionix LapMentor). The study participants can practice up to 4 hours per week, an not more than 2