Robot-Assisted Laparoscopic Myomectomy Versus Abdominal Myomectomy A Retrospective Comparison of Short-Term Surgical Outcomes.

OBJECTIVE: To compare intraoperative and postopera- tive surgical outcomes of robotic versus abdominal myo- mectomy. STUDY DESIGN: A retrospective chart review was performed using electronic medical records from Janu- ary 1, 2008-December 31, 2011, with 2008 being the first year that robotic- assisted myomectomy was performed at our institution. Intraoperative outcome data and postoperative complica- tions were reviewed as well as length of hospital stay. RESULTS: A total of 214 abdominal myomectomy cases and 165 robotic-assisted laparoscopic cases were available for review. Total operating time in minutes.was significantly longer for the robotic-assisted cases (236 ± 96) versus the abdom- inal cases (110 ± 46). Total myoma weight in grams removed was significantly greater in the abdominal myo- mectomy cases (391 ± 518) versus the robot-assisted- cases (229 ± 253). Length of stay in days was longer for abdominal cases as compared to robotic (3.3 ±1.2 vs. 1.6 ± 1). Estimated blood loss in milliliters was similar between abdominal and robotic cases (258 ± 335' vs. 241± 370). CONCLUSION: Robotic-assisted and abdominal myo- mectomies have similar surgical outcomes. However, the longer total operating time for robotic-assisted myomec- tomies is a drawback which may not be completely offset by the benefit of a shorter hospital stay.

Effect of validated skills simulation on operating room performance in obstetrics and gynecology residents: a randomized controlled trial.

OBJECTIVES: To estimate whether training on previously validated laparoscopic skill stations translates into improved technical performance in the operating room. METHODS: We performed a multicenter, randomized, controlled trial evaluating the performance of a laparoscopic bilateral midsegment salpingectomy. Residents were randomized to either traditional teaching (no simulation) or faculty-directed sessions in a simulation laboratory. A sample size of at least 44 lower-level residents (postgraduate year [PGY] 1 or 2) and 66 upper-level (PGY 3 or 4) were necessary to demonstrate a 50% improvement in performance assuming an α error of 0.05 and ß error of 0.20 for each group independently. The primary outcomes were the final total normalized simulation score and the operating room performance score. Paired t test and Wilcoxon rank-sum tests were used to evaluate the differences within and between cohorts. Our final model involved a multiple linear regression analysis for the main effects of a priori--specified variables. RESULTS: We enrolled 116 residents from eight centers across the United States. There was no statistically significant difference in baseline simulation or operative performances. Although both groups demonstrated improvement with time, the trained group improved significantly higher normalized simulation scores (378 ± 54 compared with 264 ± 86; P<.01) and higher levels of competence on the simulated tasks (96.2% compared with 61.1%; P<.01). The simulation group also had higher objective structured assessment of technical skills scores in the operating room (27.5 compared with 30.0; P=.03). CONCLUSION: We found that proficiency-based simulation offers additional benefit to traditional education for all levels of residents. The use of easily accessible, low-fidelity tasks should be incorporated into formal laparoscopic training.