Differences in Exposure to Minimally Invasive Surgery in a Sample of United States Obstetrics and Gynecology Residents.

OBJECTIVE:  The objective of this study was to assess the exposure to minimally invasive gynecologic surgery (MIGS) techniques among senior (third and fourth year) Obstetrics and Gynecology residents in the United States. METHODS:  We conducted an online cross-sectional survey among senior residents who completed a 19-item questionnaire regarding their exposure to laparoscopic and robotic cases and techniques and their access to their simulation. We performed a comparison among these residents, grouped based on the four geographical regions of the United States. RESULTS:  Senior residents, on average, performed 4.0 MIGS cases (standard deviation (SD) ±2.5), 1.0 two-handed laparoscopy (SD ±1.0), and 1.5 robotic cases (SD ±1.5) per week. The exposure to challenging skills such as extracorporeal and intracorporeal suturing and laparoendoscopic single site (LESS) surgery per week was minimal and did not vary across the nation (p=0.99, p=0.06, p=0.52, respectively). Access to dual consoles increased the number of robotic cases performed per week (p=0.01). While residents of all regions had equal access to laparoscopic box trainers (p=0.81) and laparoscopic simulators (p=0.22), residents of the southern region had less access to robotic simulators (p=0.04). CONCLUSION:  The number of MIGS cases performed by residents did not differ nationwide. However, exposure to advanced aspects of endoscopy training was minimal. The presence of a fellowship or type of teaching environment did not alter the number of cases performed by residents. Residents performed a greater number of robotic cases with the presence of dual consoles.

The Relationship between Status at Presentation and Outcomes among Pregnant Women with COVID-19.

OBJECTIVE: This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19). STUDY DESIGN: This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic. All testing was done by nasopharyngeal swab using polymerase chain reaction (PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Initially, nasopharyngeal testing was performed only on women with a positive screen (symptoms or exposure) but subsequently, testing was universally performed on all women admitted to labor and delivery. Chi-square and Wilcoxon's rank-sum tests were used to compare outcomes between groups. RESULTS: Eighty-one patients were tested because of a positive screen (symptoms [n = 60] or exposure only [n = 21]) and 75 patients were universally tested (all asymptomatic). In total, there were 46 symptomatic women and 22 asymptomatic women (tested based on exposure only [n = 12] or as part of universal screening [n = 10]) with confirmed COVID-19. Of symptomatic women (n = 46), 27.3% had preterm delivery and 26.1% needed respiratory support while none of the asymptomatic women (n = 22) had preterm delivery or need of respiratory support (p = 0.007 and 0.01, respectively). CONCLUSION: Pregnant women who presented with COVID19-related symptoms and subsequently tested positive for COVID-19 have a higher rate of preterm delivery and need for respiratory support than asymptomatic pregnant women. It is important to be particularly rigorous in caring for COVID-19 infected pregnant women who present with symptoms. KEY POINTS: · Respiratory support is often needed for women who present with symptoms.. · Low rate of severe disease in women who present without symptoms.. · There were no neonatal infections on day 0 of life..