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Warm-Up Before Robotic Hysterectomy Does Not Improve Trainee Operative Performance: A Randomized Trial
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
specimen extracorporeally utilizing a C-incision technique, and inspecting the bag at the completion of morcellation. Measurements and Main Results: Pre- and post session checklists of completed tasks, numeric rating scales (0-10) of self-reported competency in morcellation, and a binary rating of simulation realism were utilized. 9/16 junior (PGY 1-2) and 7/16 senior residents (PGY 3-4) participated in the study. Only 3/164 combined laparoscopic hysterectomies/ myomectomies involved standard power morcellation in cases involving participating residents in the last year. In contrast, 46 cases of hand morcellation had been observed (42 using an in-bag technique). 50% perceived that the recent morcellation controversy had reduced minimally invasive case volumes. There was a significant positive effect of training on perceived comfort with hand morcellation following the training session (mean comfort 3.81, SD 3.25 pre sim vs. mean comfort 5.94 SD 2.4, post sim), p = 0.003. 88% of residents rated the morcellation model realistic. Among, junior residents the most difficult tasks were opening the bag within the laparoscopic trainer and placement of the specimen into the bag within the restricted time frame. Conclusion: Residents readily demonstrate basic competency in key steps within a structured 20 minute training session. This simulation provides another example of how a portion of a procedure can be broken down and introduced/taught to trainees. Further studies validating the model and assessments are required.
Global Evaluative Assessment for Robotic Surgery (GEARS). Assessment was made by attending faculty who were blinded to the warm-up randomization. Given the observed effect of preoperative warm-up, a post-hoc conditional power analysis was computed. Measurements and Main Results: We randomized 66 cases and after excluding 4 cases in each group for reasons unrelated to trainee performance, we analyzed 58 cases (30 warm-up, 28 no warm-up), which involved 23 trainees. Overall, faculty rated trainees similarly irrespective of warm-up randomization. The conditional power analysis showed that our study had little power to detect the unanticipated small effect of warm-up. A study with twice the number of trainees than our study would have only had sufficient power to detect an effect nine times that observed in our trial. Of the cases performed with warm-up, 91.2% of the trainees felt that warming-up helped their operative performances. Using a generalized linear mix model, number of previous robotic hysterectomies (b=0.24, P=.01) and being a fellow (b=9.41, P=.01) were independent predictors of higher GEARS scores. Conclusion: Performing a brief virtual reality warm-up exercise before robotic hysterectomy did not significantly improve the operative performances of trainees. In most instances, trainees felt that warming-up before the case was beneficial. Trainees with more training and robotic surgical experience received higher performance scores.
83 Warm-Up Before Robotic Hysterectomy Does Not Improve Trainee Operative Performance: A Randomized Trial Chen CCG,1 Tanner E,1 Malpani A,2 Vedula SS,2 Fader AN,1 Scheib SA,1 Green IC,1 Hager GD.2 1Gynob, Johns Hopkins, Baltimore, Maryland; 2 Computer Science, Johns Hopkins University, Baltimore, Maryland Study Objective: To assess the impact of immediate preoperative warm-up using a robotic simulator on operative robotic hysterectomy performance by trainees. Design: Benign or early cancer robotic hysterectomy cases were randomized to be performed with or without preoperative warm-up. Setting: Academic gynecology/ obstetrics department. Patients: Gynecology trainees. Intervention: Trainees assigned to cases that randomized to warm-up performed a set of exercises on a robotic virtual reality simulator immediately before cases. Operative performance was scored using the previously validated Objective Structured Assessment of Technical Skill global rating scale originally designed for open general surgery and the
84
Open Communications 4 - Research (12:05 PM - 1:05 PM)
Abstract Withdrawn 85 Impact of a Minimally Invasive Gynecologic Surgeon on Patient Outcomes Following Laparoscopic Hysterectomy Clark NV,1 Moreno-Koehler AD,2 Sebba AL,1 Gujral HS,1 Wright KN.1 1 Department of Gynecology, Lahey Hospital and Medical Center, Burlington, Massachusetts; 2Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts Study Objective: To determine the impact of a fellowship-trained minimally invasive gynecologic surgeon on patient outcomes following laparoscopic hysterectomy (LH) in a gynecology department. Design: Review of 239 patients who underwent an LH for benign indications by a gynecology department from 2010 to 2014. Setting: A suburban academic-affiliated tertiary care hospital with a broad patient base. Patients: 239 women who underwent an LH between 2010 and 2014. Intervention: Total and supracervical LH. Measurements and Main Results: 239 women underwent conventional LH by 11 members of a gynecology department; 96 women (40%) by a fellowship-trained minimally invasive gynecologic surgery (MIGS) specialist and 143 women (60%) by a group of general gynecologists and gynecologic oncologists. Operative time was less for the MIGS surgeon (119 vs. 145 minutes, p \ 0.001). Patients were more likely to be discharged on the same day for the MIGS surgeon compared to other surgeons (90.6% vs. 59.4%, p \ 0.001). Costs were lower for the MIGS surgeon with a median total billing charge of $10,782.00 vs. $11,955.00 (p = 0.001). Patient characteristics were similar for age (46.8 vs. 46.7 years, p = 0.91) and BMI (28.2 vs. 27.4, p = 0.33). Patient characteristics differed in the number of prior laparotomies (0.71 vs. 0.31, p = 0.002), prior laparoscopies (0.71 vs. 0.44, p = 0.038) and uterine weight (392 vs. 209 grams, p \ 0.001). Complications were rare for both groups. While not statistically significant, postoperative infections (6 vs. 19 cases, p = 0.08) were lower for the MIGS surgeon. Conclusion: A fellowship-trained MIGS surgeon performed LH more efficiently on more difficult surgical patients, with a shorter LOS and lower costs, and no difference in complications compared to other providers in a gynecology department.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
specimen extracorporeally utilizing a C-incision technique, and inspecting the bag at the completion of morcellation. Measurements and Main Results: Pre- and post session checklists of completed tasks, numeric rating scales (0-10) of self-reported competency in morcellation, and a binary rating of simulation realism were utilized. 9/16 junior (PGY 1-2) and 7/16 senior residents (PGY 3-4) participated in the study. Only 3/164 combined laparoscopic hysterectomies/ myomectomies involved standard power morcellation in cases involving participating residents in the last year. In contrast, 46 cases of hand morcellation had been observed (42 using an in-bag technique). 50% perceived that the recent morcellation controversy had reduced minimally invasive case volumes. There was a significant positive effect of training on perceived comfort with hand morcellation following the training session (mean comfort 3.81, SD 3.25 pre sim vs. mean comfort 5.94 SD 2.4, post sim), p = 0.003. 88% of residents rated the morcellation model realistic. Among, junior residents the most difficult tasks were opening the bag within the laparoscopic trainer and placement of the specimen into the bag within the restricted time frame. Conclusion: Residents readily demonstrate basic competency in key steps within a structured 20 minute training session. This simulation provides another example of how a portion of a procedure can be broken down and introduced/taught to trainees. Further studies validating the model and assessments are required.
Global Evaluative Assessment for Robotic Surgery (GEARS). Assessment was made by attending faculty who were blinded to the warm-up randomization. Given the observed effect of preoperative warm-up, a post-hoc conditional power analysis was computed. Measurements and Main Results: We randomized 66 cases and after excluding 4 cases in each group for reasons unrelated to trainee performance, we analyzed 58 cases (30 warm-up, 28 no warm-up), which involved 23 trainees. Overall, faculty rated trainees similarly irrespective of warm-up randomization. The conditional power analysis showed that our study had little power to detect the unanticipated small effect of warm-up. A study with twice the number of trainees than our study would have only had sufficient power to detect an effect nine times that observed in our trial. Of the cases performed with warm-up, 91.2% of the trainees felt that warming-up helped their operative performances. Using a generalized linear mix model, number of previous robotic hysterectomies (b=0.24, P=.01) and being a fellow (b=9.41, P=.01) were independent predictors of higher GEARS scores. Conclusion: Performing a brief virtual reality warm-up exercise before robotic hysterectomy did not significantly improve the operative performances of trainees. In most instances, trainees felt that warming-up before the case was beneficial. Trainees with more training and robotic surgical experience received higher performance scores.
83 Warm-Up Before Robotic Hysterectomy Does Not Improve Trainee Operative Performance: A Randomized Trial Chen CCG,1 Tanner E,1 Malpani A,2 Vedula SS,2 Fader AN,1 Scheib SA,1 Green IC,1 Hager GD.2 1Gynob, Johns Hopkins, Baltimore, Maryland; 2 Computer Science, Johns Hopkins University, Baltimore, Maryland Study Objective: To assess the impact of immediate preoperative warm-up using a robotic simulator on operative robotic hysterectomy performance by trainees. Design: Benign or early cancer robotic hysterectomy cases were randomized to be performed with or without preoperative warm-up. Setting: Academic gynecology/ obstetrics department. Patients: Gynecology trainees. Intervention: Trainees assigned to cases that randomized to warm-up performed a set of exercises on a robotic virtual reality simulator immediately before cases. Operative performance was scored using the previously validated Objective Structured Assessment of Technical Skill global rating scale originally designed for open general surgery and the
84
Open Communications 4 - Research (12:05 PM - 1:05 PM)
Abstract Withdrawn 85 Impact of a Minimally Invasive Gynecologic Surgeon on Patient Outcomes Following Laparoscopic Hysterectomy Clark NV,1 Moreno-Koehler AD,2 Sebba AL,1 Gujral HS,1 Wright KN.1 1 Department of Gynecology, Lahey Hospital and Medical Center, Burlington, Massachusetts; 2Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts Study Objective: To determine the impact of a fellowship-trained minimally invasive gynecologic surgeon on patient outcomes following laparoscopic hysterectomy (LH) in a gynecology department. Design: Review of 239 patients who underwent an LH for benign indications by a gynecology department from 2010 to 2014. Setting: A suburban academic-affiliated tertiary care hospital with a broad patient base. Patients: 239 women who underwent an LH between 2010 and 2014. Intervention: Total and supracervical LH. Measurements and Main Results: 239 women underwent conventional LH by 11 members of a gynecology department; 96 women (40%) by a fellowship-trained minimally invasive gynecologic surgery (MIGS) specialist and 143 women (60%) by a group of general gynecologists and gynecologic oncologists. Operative time was less for the MIGS surgeon (119 vs. 145 minutes, p \ 0.001). Patients were more likely to be discharged on the same day for the MIGS surgeon compared to other surgeons (90.6% vs. 59.4%, p \ 0.001). Costs were lower for the MIGS surgeon with a median total billing charge of $10,782.00 vs. $11,955.00 (p = 0.001). Patient characteristics were similar for age (46.8 vs. 46.7 years, p = 0.91) and BMI (28.2 vs. 27.4, p = 0.33). Patient characteristics differed in the number of prior laparotomies (0.71 vs. 0.31, p = 0.002), prior laparoscopies (0.71 vs. 0.44, p = 0.038) and uterine weight (392 vs. 209 grams, p \ 0.001). Complications were rare for both groups. While not statistically significant, postoperative infections (6 vs. 19 cases, p = 0.08) were lower for the MIGS surgeon. Conclusion: A fellowship-trained MIGS surgeon performed LH more efficiently on more difficult surgical patients, with a shorter LOS and lower costs, and no difference in complications compared to other providers in a gynecology department.