Virtual postoperative visits following robotic gynecologic surgery: a study of patient satisfaction, safety, and feasibility.

Since the onset of the COVID-19 pandemic the use of telehealth has burgeoned. Numerous surgical specialties have already adopted the use of virtual postoperative visits, but there is data lacking in both robotics and gynecology. In this single-institution prospective cohort study we sought to evaluate the patient satisfaction, feasibility and safety of postoperative telehealth visits following robotic gynecologic surgery. Thirty-three patients undergoing robotic gynecologic procedures participated in a postoperative telehealth visit approximately 2 weeks following surgery, of which 27 completed a survey which assessed participant satisfaction with the telehealth visit, overall health-related quality of life following surgery, exposure to telehealth visits, and social determinants of health. The mean satisfaction score was just below 'excellent'. Only 2 participants (6.3%) required an in-person visit. Postoperative telehealth visit satisfaction score was significantly associated only with BMI (Pearson r = 0.45, p = 0.018). These data suggest that telehealth visits following robotic gynecologic procedures appear to be safe and feasible, and are associated with a high level of patient satisfaction.

Unintended Pregnancy in the Military Health Care System: Who is Really at Risk?

Unintended pregnancy is a global issue and one that is reportedly to be higher in the military population. We sought to assess rates of unintended pregnancy among the active duty population in comparison to other military health care beneficiaries. Using a validated six-question survey, patients aged 18 to 42 were surveyed in five different clinics at three major tertiary hospitals from December 2013 to December 2014. Individual survey questions were scored 0, 1, or 2 and a total score was tabulated. A total score of 0 to 3 indicated unintended pregnancy, 4 to 9 indicated ambivalence toward pregnancy, and 10 to 12 indicated intended pregnancy. Subanalysis was performed on two survey questions specifically looking at pregnancy intentions. A total of 1,211 completed surveys were analyzed. Overall, 6.9% of all respondents had an unintended pregnancy compared to 23% of pregnancies in single active duty women. Single, active duty service members were more likely to indicate they did not intend to get pregnant or want a baby before becoming pregnant. Overall, the rate of unintended pregnancy among military health care beneficiaries is low. However, single active duty women are at significantly higher risk for unintended pregnancy and specifically targeted interventions should be implemented for this population.

Comparison of two simulation systems to support robotic-assisted surgical training: a pilot study (Swine model).

OBJECTIVE: To compare the efficacy of simulation-based training between the Mimic dV- Trainer and traditional dry lab da Vinci robot training. DESIGN: A prospective randomized study analyzing the performance of 20 robotics-naive participants. Participants were enrolled in an online da Vinci Intuitive Surgical didactic training module, followed by training in use of the da Vinci standard surgical robot. Spatial ability tests were performed as well. Participants were randomly assigned to 1 of 2 training conditions: performance of 3 Fundamentals of Laparoscopic Surgery dry lab tasks using the da Vinci or performance of 4 dV-Trainer tasks. Participants in both groups performed all tasks to empirically establish proficiency criterion. Participants then performed the transfer task, a cystotomy closure using the daVinci robot on a live animal (swine) model. The performance of robotic tasks was blindly assessed by a panel of experienced surgeons using objective tracking data and using the validated Global Evaluative Assessment of Robotic Surgery (GEARS), a structured assessment tool. RESULTS: No statistically significant difference in surgeon performance was found between the 2 training conditions, dV-Trainer and da Vinci robot. Analysis of a 95% confidence interval for the difference in means (-0.803 to 0.543) indicated that the 2 methods are unlikely to differ to an extent that would be clinically meaningful. CONCLUSION: Based on the results of this study, a curriculum on the dV- Trainer was shown to be comparable to traditional da Vinci robot training. Therefore, we have identified that training on a virtual reality system may be an alternative to live animal training for future robotic surgeons.

Comparison of robotic, laparoscopic, and abdominal myomectomy in a community hospital.

BACKGROUND AND OBJECTIVES: To evaluate the operative outcomes between robotic, laparoscopic, and abdominal myomectomies performed by a private gynecologic oncology practice in a suburban community hospital. METHODS: The medical records of 322 consecutive robotic, laparoscopic, and abdominal myomectomies performed from January 2007 through December 2009 were reviewed. The outcomes were collected from a retrospective review of patient medical records. RESULTS: Records for 14/322 (4.3%) patients were incomplete. Complete data were available for 308 patients, including 169 (54.9%) abdominal, 73 (23.7%) laparoscopic, and 66 (21.4%) robotic-assisted laparoscopic myomectomies. Patients were similar in age, body mass index, parity, and previous abdominopelvic surgery. Median operative time for robotic surgery (140 min) was significantly longer (P<.005) compared to laparoscopic (70 min) and abdominal (72 min) myomectomies. Robotic and laparoscopic myomectomies had significantly less estimated blood loss and hospital stay compared to abdominal myomectomies. There was no significant difference in complications or in the median size of the largest myoma removed between the different modalities. However, the median aggregate weight of myomas removed abdominally (200g; range, 1.4 to 2682) was significantly larger than that seen laparoscopically (115g; range, 1 to 602) and robotically (129g; range 9.4 to 935). Postoperative transfusion was significantly less frequent in robotic myomectomies compared to laparoscopic and abdominal myomectomies. CONCLUSION: While robotic-assisted laparoscopic myomectomies had longer operative times, laparoscopic and robotic assisted laparoscopic myomectomies demonstrated shorter hospital stays, less blood loss, and fewer transfusions than abdominal myomectomies. Robotic myomectomy offers a minimally invasive alternative for management of symptomatic myoma in a community hospital setting.

Barbed versus standard suture: a randomized trial for laparoscopic vaginal cuff closure.

STUDY OBJECTIVE: To compare closure times, cuff healing, and postoperative dyspareunia between barbed and traditional sutures during laparoscopic total hysterectomy. DESIGN: A randomized clinical trial (Canadian Task Force classification I). SETTING: A university hospital. PATIENTS: Sixty-three women undergoing total laparoscopic hysterectomy. INTERVENTIONS: Total laparoscopic hysterectomy was performed using standard techniques. The vaginal cuff closure method was randomized to barbed suture (Quill; Angiotech Pharmaceuticals, Inc., Vancouver, Canada) or standard suture (Vicryl; Ethicon Inc., Somerville, NJ). The time required for cuff closure was documented. Patients were examined postoperatively to assess cuff healing, and a standardized sexual function questionnaire was administered preoperatively and at 3 months postoperatively. MEASUREMENTS AND MAIN RESULTS: The mean vaginal cuff closure time was 10.4 minutes versus 9.6 minutes in the barbed versus standard suture group (p = .51). Cuff healing appeared similar between the 2 groups. Rates of dyspareunia, partner dyspareunia, and sexual function were similar in both groups at 3 months postoperatively. Vaginal cuff closure times were significantly faster among attendings compared with residents/fellows (7.1 vs. 12.8 minutes, respectively; p < .0001). The study was designed to have a statistical power of 80% to detect a difference of 5 minutes in cuff closure time between the 2 groups (α level of 0.05). CONCLUSION: Laparoscopic vaginal cuff closure times are similar when using barbed sutures and braided sutures.

Survey of robotic surgery training in obstetrics and gynecology residency.

To examine the status of resident training in robotic surgery in obstetrics and gynecology programs in the United States, an online survey was emailed to residency program directors of 247 accredited programs identified through the Accreditation Council for Graduate Medical Education website. Eighty-three of 247 program directors responded, representing a 34% response rate. Robotic surgical systems for gynecologic procedures were used at 65 (78%) institutions. Robotic surgery training was part of residency curriculum at 48 (58%) residency programs. Half of respondents were undecided on training effectiveness. Most program directors believed the role of robotic surgery would increase and play a more integral role in gynecologic surgery. Robotic surgery was widely reported in residency training hospitals with limited availability of effective resident training. Robotic surgery training in obstetrics and gynecology residency needs further assessment and may benefit from a structured curriculum.