Minimally Invasive Surgery Week

NEW YORK – Power morcellation has been highly controversial since the Food and Drug Administration warned against its use in the majority of women undergoing myomectomy or hysterectomy for fibroid treatment last year. So where does that leave ob.gyns. who perform minimally invasive surgery?

At the annual Minimally Invasive Surgery Week, experts from around the world discussed alternative methods for tumor or organ extraction that are safe and can be used with minimally invasive techniques.

Dr. Antonio Curyof Positivo University in Curitiba, Brazil, highlighted the importance of surgical techniques to prevent port site metastasis.

Courtesy Dr. Tony Shibley

There are three theories about how these occur: tumor-related, wound-related, and surgical technique–related metastases, he said. Focusing on the surgical technique, he said that contamination is likely the cause.

“Tumor manipulation is the principal factor. Avoid violating the tumor boundary. Avoid gas leakage, as well. I use a single trocar tight to the skin to avoid gas leakage,” Dr. Cury said. “Do not touch the tumor. Use instruments to extract the tumor and avoid rupture.”

Morcellation can be considered cautiously, he said, but use a bag and protect the wound.

“Surgical techniques are related to port site metastasis. Surgical and laparoscopic principles need to be taught. The learning curve is important,” said Dr. Cury, who is on the speakers bureau for and a consultant to Medtronic and Covidien.

In-bag morcellation appears to be the evolving alternative to unprotected power morcellation by minimizing the risk of intraperitoneal tissue dissemination, said Dr. Ceana Nezhat, director of the Nezhat Medical Center in Atlanta.

Tissue extraction transvaginally or via laparoscopic-assisted minilaparotomy is one option. “Using this technique, the patient has the benefit of minimally access surgery without concern about unprotected power morcellation,” said Dr. Nezhat, who reported being a consultant for Karl Storz Endoscopy and a medical adviser to Plasma Surgery, and serving on the advisory board for SurgiQuest.

When performing morcellation with a containment bag, Dr. Jens Rassweiler said it’s important that the bag is stable. “We have to try to get the whole tumor specimen with morcellation. Then we put the pieces together for the pathologist. We have to beware of the risk of tumor spillage,” said Dr. Rassweiler of Klinikum Heilbronn, the academic hospital of the University of Heidelberg, Germany.

The type of extraction bag is important, he said. The bag should be self-opening, have enough working space, and should not be permeable. Several types of extraction bags are available but none is perfect, he told listeners. Newer bags are under development, according to Dr. Rassweiler, who reported having no relevant financial disclosures.

Dr. Nezhat emphasized that surgeons have an important role to play in the public debate on morcellation and its alternatives.

“The power of public opinion has put us where we are. There were reports of injuries, tissue disruption, and dispersion prior to the 2013 public campaign to ban power morcellation. In light of the FDA black box warning, we have to make decisions on how to improve morcellation, with new instrumentation and proper training. We also have to get our patients involved in the decision-making process. It is imperative to educate and inform the patient of the potential risks.”

NEW YORK – Power morcellation has been highly controversial since the Food and Drug Administration warned against its use in the majority of women undergoing myomectomy or hysterectomy for fibroid treatment last year. So where does that leave ob.gyns. who perform minimally invasive surgery?

At the annual Minimally Invasive Surgery Week, experts from around the world discussed alternative methods for tumor or organ extraction that are safe and can be used with minimally invasive techniques.

Dr. Antonio Curyof Positivo University in Curitiba, Brazil, highlighted the importance of surgical techniques to prevent port site metastasis.

Courtesy Dr. Tony Shibley

There are three theories about how these occur: tumor-related, wound-related, and surgical technique–related metastases, he said. Focusing on the surgical technique, he said that contamination is likely the cause.

“Tumor manipulation is the principal factor. Avoid violating the tumor boundary. Avoid gas leakage, as well. I use a single trocar tight to the skin to avoid gas leakage,” Dr. Cury said. “Do not touch the tumor. Use instruments to extract the tumor and avoid rupture.”

Morcellation can be considered cautiously, he said, but use a bag and protect the wound.

“Surgical techniques are related to port site metastasis. Surgical and laparoscopic principles need to be taught. The learning curve is important,” said Dr. Cury, who is on the speakers bureau for and a consultant to Medtronic and Covidien.

In-bag morcellation appears to be the evolving alternative to unprotected power morcellation by minimizing the risk of intraperitoneal tissue dissemination, said Dr. Ceana Nezhat, director of the Nezhat Medical Center in Atlanta.

Tissue extraction transvaginally or via laparoscopic-assisted minilaparotomy is one option. “Using this technique, the patient has the benefit of minimally access surgery without concern about unprotected power morcellation,” said Dr. Nezhat, who reported being a consultant for Karl Storz Endoscopy and a medical adviser to Plasma Surgery, and serving on the advisory board for SurgiQuest.

When performing morcellation with a containment bag, Dr. Jens Rassweiler said it’s important that the bag is stable. “We have to try to get the whole tumor specimen with morcellation. Then we put the pieces together for the pathologist. We have to beware of the risk of tumor spillage,” said Dr. Rassweiler of Klinikum Heilbronn, the academic hospital of the University of Heidelberg, Germany.

The type of extraction bag is important, he said. The bag should be self-opening, have enough working space, and should not be permeable. Several types of extraction bags are available but none is perfect, he told listeners. Newer bags are under development, according to Dr. Rassweiler, who reported having no relevant financial disclosures.

Dr. Nezhat emphasized that surgeons have an important role to play in the public debate on morcellation and its alternatives.

“The power of public opinion has put us where we are. There were reports of injuries, tissue disruption, and dispersion prior to the 2013 public campaign to ban power morcellation. In light of the FDA black box warning, we have to make decisions on how to improve morcellation, with new instrumentation and proper training. We also have to get our patients involved in the decision-making process. It is imperative to educate and inform the patient of the potential risks.”

NEW YORK – Power morcellation has been highly controversial since the Food and Drug Administration warned against its use in the majority of women undergoing myomectomy or hysterectomy for fibroid treatment last year. So where does that leave ob.gyns. who perform minimally invasive surgery?

At the annual Minimally Invasive Surgery Week, experts from around the world discussed alternative methods for tumor or organ extraction that are safe and can be used with minimally invasive techniques.

Dr. Antonio Curyof Positivo University in Curitiba, Brazil, highlighted the importance of surgical techniques to prevent port site metastasis.

Courtesy Dr. Tony Shibley

There are three theories about how these occur: tumor-related, wound-related, and surgical technique–related metastases, he said. Focusing on the surgical technique, he said that contamination is likely the cause.

“Tumor manipulation is the principal factor. Avoid violating the tumor boundary. Avoid gas leakage, as well. I use a single trocar tight to the skin to avoid gas leakage,” Dr. Cury said. “Do not touch the tumor. Use instruments to extract the tumor and avoid rupture.”

Morcellation can be considered cautiously, he said, but use a bag and protect the wound.

“Surgical techniques are related to port site metastasis. Surgical and laparoscopic principles need to be taught. The learning curve is important,” said Dr. Cury, who is on the speakers bureau for and a consultant to Medtronic and Covidien.

In-bag morcellation appears to be the evolving alternative to unprotected power morcellation by minimizing the risk of intraperitoneal tissue dissemination, said Dr. Ceana Nezhat, director of the Nezhat Medical Center in Atlanta.

Tissue extraction transvaginally or via laparoscopic-assisted minilaparotomy is one option. “Using this technique, the patient has the benefit of minimally access surgery without concern about unprotected power morcellation,” said Dr. Nezhat, who reported being a consultant for Karl Storz Endoscopy and a medical adviser to Plasma Surgery, and serving on the advisory board for SurgiQuest.

When performing morcellation with a containment bag, Dr. Jens Rassweiler said it’s important that the bag is stable. “We have to try to get the whole tumor specimen with morcellation. Then we put the pieces together for the pathologist. We have to beware of the risk of tumor spillage,” said Dr. Rassweiler of Klinikum Heilbronn, the academic hospital of the University of Heidelberg, Germany.

The type of extraction bag is important, he said. The bag should be self-opening, have enough working space, and should not be permeable. Several types of extraction bags are available but none is perfect, he told listeners. Newer bags are under development, according to Dr. Rassweiler, who reported having no relevant financial disclosures.

Dr. Nezhat emphasized that surgeons have an important role to play in the public debate on morcellation and its alternatives.

“The power of public opinion has put us where we are. There were reports of injuries, tissue disruption, and dispersion prior to the 2013 public campaign to ban power morcellation. In light of the FDA black box warning, we have to make decisions on how to improve morcellation, with new instrumentation and proper training. We also have to get our patients involved in the decision-making process. It is imperative to educate and inform the patient of the potential risks.”

NEW YORK – The next big advance in gynecologic minimally invasive surgery could be the wider adoption of minilaparoscopy using newer, frictionless instruments.

Minilaparoscopy is commonly used in cholecystectomy, but is making inroads in gynecology. Minilaparoscopy performed with the newer, smaller instruments is especially well suited for fertility procedures and endometriosis surgery, according to Dr. Gustavo Carvalho, a pioneer in minilaparoscopy. Gynecologists are using minilaparoscopy successfully in hysterectomy as well, but the mini-instruments are not strong enough to survive many hysterectomies, he added.

“Traditional laparoscopy is suited for brutal procedures, such as hysterectomy, but minilap is better for delicate procedures requiring precise, tiny instruments,” Dr. Carvalho said at the meeting.

Despite the promise of utilizing the newer instruments, many surgeons have misconceptions about them.

“This is partly related to instruments used in older procedures called minilap. But after they try it with these newer instruments and learn how to do it, they actually prefer it for many procedures,” Dr. Carvalho, an associate professor of general surgery at Pernambuco University, Recife, Brazil, said in an interview.

Dr. Carvalho debunked the following “myths” about minilaparoscopy:

1. Single-port laparoscopy is cosmetically superior to minilaparoscopy. That’s not the case, Dr. Carvalho said. The few published papers on this subject compared single-port laparoscopy with older, high-friction instruments for minilaparoscopy, he said.

2. Minilaparoscopy should not be performed on obese patients. That’s false, Dr. Carvalho said. “Using newer instruments, we can move around better and see better for delicate operations in obese patients, but surgeons need special training,” he said.

3. Patients don’t want minilaparoscopy. The only published paper looking at patient preference did not offer patients minilaparoscopy with the newer instruments, Dr. Carvalho said. He and his colleagues plans to publish a paper based on research showing that 47% of patients prefer minilaparoscopy, compared with 27% who preferred single-port procedures. “There is a role for single-port procedures,” he added.

4. Minilaparoscopy hurts more than single-port laparoscopy. “No one can prove that minilap hurts less, but it is obvious and intuitive that smaller trocars and instruments cause less pain,” Dr. Carvalho said. “Surgeons want randomized trials, but they won’t be done because this is obvious.”

5. Surgeons lose dexterity and precision with minilaparoscopy. In new research that will be published in the Journal of the Society Laparoendoscopic Surgeons, Dr. Caravalho and his colleagues demonstrate that newer minilaparoscopy instruments are better than larger instruments for delicate tasks. In this study, 22 medical students and 22 surgical residents were given one gross task and three delicate tasks to perform randomly with a 3-mm frictionless trocar, a 3-mm high-friction trocar, and a 5-mm trocar. The larger instruments were significantly better for the gross task, while the smaller instruments were significantly better for the delicate tasks, Dr. Carvalho said. “This study shows the utility of precise, delicate instruments for delicate procedures,” he said.

Dr. Caravalho reported that he is an unpaid consultant for Karl Storz on the development of minilaparoscopic low-friction trocars. 

NEW YORK – The next big advance in gynecologic minimally invasive surgery could be the wider adoption of minilaparoscopy using newer, frictionless instruments.

Minilaparoscopy is commonly used in cholecystectomy, but is making inroads in gynecology. Minilaparoscopy performed with the newer, smaller instruments is especially well suited for fertility procedures and endometriosis surgery, according to Dr. Gustavo Carvalho, a pioneer in minilaparoscopy. Gynecologists are using minilaparoscopy successfully in hysterectomy as well, but the mini-instruments are not strong enough to survive many hysterectomies, he added.

“Traditional laparoscopy is suited for brutal procedures, such as hysterectomy, but minilap is better for delicate procedures requiring precise, tiny instruments,” Dr. Carvalho said at the meeting.

Despite the promise of utilizing the newer instruments, many surgeons have misconceptions about them.

“This is partly related to instruments used in older procedures called minilap. But after they try it with these newer instruments and learn how to do it, they actually prefer it for many procedures,” Dr. Carvalho, an associate professor of general surgery at Pernambuco University, Recife, Brazil, said in an interview.

Dr. Carvalho debunked the following “myths” about minilaparoscopy:

1. Single-port laparoscopy is cosmetically superior to minilaparoscopy. That’s not the case, Dr. Carvalho said. The few published papers on this subject compared single-port laparoscopy with older, high-friction instruments for minilaparoscopy, he said.

2. Minilaparoscopy should not be performed on obese patients. That’s false, Dr. Carvalho said. “Using newer instruments, we can move around better and see better for delicate operations in obese patients, but surgeons need special training,” he said.

3. Patients don’t want minilaparoscopy. The only published paper looking at patient preference did not offer patients minilaparoscopy with the newer instruments, Dr. Carvalho said. He and his colleagues plans to publish a paper based on research showing that 47% of patients prefer minilaparoscopy, compared with 27% who preferred single-port procedures. “There is a role for single-port procedures,” he added.

4. Minilaparoscopy hurts more than single-port laparoscopy. “No one can prove that minilap hurts less, but it is obvious and intuitive that smaller trocars and instruments cause less pain,” Dr. Carvalho said. “Surgeons want randomized trials, but they won’t be done because this is obvious.”

5. Surgeons lose dexterity and precision with minilaparoscopy. In new research that will be published in the Journal of the Society Laparoendoscopic Surgeons, Dr. Caravalho and his colleagues demonstrate that newer minilaparoscopy instruments are better than larger instruments for delicate tasks. In this study, 22 medical students and 22 surgical residents were given one gross task and three delicate tasks to perform randomly with a 3-mm frictionless trocar, a 3-mm high-friction trocar, and a 5-mm trocar. The larger instruments were significantly better for the gross task, while the smaller instruments were significantly better for the delicate tasks, Dr. Carvalho said. “This study shows the utility of precise, delicate instruments for delicate procedures,” he said.

Dr. Caravalho reported that he is an unpaid consultant for Karl Storz on the development of minilaparoscopic low-friction trocars. 

NEW YORK – The next big advance in gynecologic minimally invasive surgery could be the wider adoption of minilaparoscopy using newer, frictionless instruments.

Minilaparoscopy is commonly used in cholecystectomy, but is making inroads in gynecology. Minilaparoscopy performed with the newer, smaller instruments is especially well suited for fertility procedures and endometriosis surgery, according to Dr. Gustavo Carvalho, a pioneer in minilaparoscopy. Gynecologists are using minilaparoscopy successfully in hysterectomy as well, but the mini-instruments are not strong enough to survive many hysterectomies, he added.

“Traditional laparoscopy is suited for brutal procedures, such as hysterectomy, but minilap is better for delicate procedures requiring precise, tiny instruments,” Dr. Carvalho said at the meeting.

Despite the promise of utilizing the newer instruments, many surgeons have misconceptions about them.

“This is partly related to instruments used in older procedures called minilap. But after they try it with these newer instruments and learn how to do it, they actually prefer it for many procedures,” Dr. Carvalho, an associate professor of general surgery at Pernambuco University, Recife, Brazil, said in an interview.

Dr. Carvalho debunked the following “myths” about minilaparoscopy:

1. Single-port laparoscopy is cosmetically superior to minilaparoscopy. That’s not the case, Dr. Carvalho said. The few published papers on this subject compared single-port laparoscopy with older, high-friction instruments for minilaparoscopy, he said.

2. Minilaparoscopy should not be performed on obese patients. That’s false, Dr. Carvalho said. “Using newer instruments, we can move around better and see better for delicate operations in obese patients, but surgeons need special training,” he said.

3. Patients don’t want minilaparoscopy. The only published paper looking at patient preference did not offer patients minilaparoscopy with the newer instruments, Dr. Carvalho said. He and his colleagues plans to publish a paper based on research showing that 47% of patients prefer minilaparoscopy, compared with 27% who preferred single-port procedures. “There is a role for single-port procedures,” he added.

4. Minilaparoscopy hurts more than single-port laparoscopy. “No one can prove that minilap hurts less, but it is obvious and intuitive that smaller trocars and instruments cause less pain,” Dr. Carvalho said. “Surgeons want randomized trials, but they won’t be done because this is obvious.”

5. Surgeons lose dexterity and precision with minilaparoscopy. In new research that will be published in the Journal of the Society Laparoendoscopic Surgeons, Dr. Caravalho and his colleagues demonstrate that newer minilaparoscopy instruments are better than larger instruments for delicate tasks. In this study, 22 medical students and 22 surgical residents were given one gross task and three delicate tasks to perform randomly with a 3-mm frictionless trocar, a 3-mm high-friction trocar, and a 5-mm trocar. The larger instruments were significantly better for the gross task, while the smaller instruments were significantly better for the delicate tasks, Dr. Carvalho said. “This study shows the utility of precise, delicate instruments for delicate procedures,” he said.

Dr. Caravalho reported that he is an unpaid consultant for Karl Storz on the development of minilaparoscopic low-friction trocars. 

NEW YORK – Certification programs for minimally invasive surgery should be more rigorous and continuous, relying on simulation and other hands-on tests of skills, according to Dr. Larry R. Glazerman.

Having rigorous certification could improve the uptake of minimally invasive techniques among patients and encourage insurers to pay for these procedures, he said at the annual Minimally Invasive Surgery Week.

“Right now there is no specific, universally accepted certification in gynecologic laparoscopy. We need certification to go beyond what is currently required. Our certification and recertification standards should confirm competence and confidence,” said Dr. Glazerman, medical director of Planned Parenthood of Delaware.

Several factors contribute to the lack of focus on certification, as well as low uptake of minimally invasive surgery (MIS) by gynecologists. The first is that gynecologists wear “many hats,” he said.

“They serve as primary care doctors, obstetricians, and gynecologists. Also a unique, and negative, feature is that gynecology is the only surgical specialty with a preexisting, ongoing, trusting relationship with the patient. Most gynecologists use traditional surgery, not MIS,” he said.

And gynecologists spend less than half of their training time on surgery, compared with other surgical specialties, he added.

Currently, the American Board of Obstetrics and Gynecology offers certification in obstetrics and gynecology, as well as in the subspecialities of gynecologic oncology, maternal-fetal medicine, reproductive endocrinology and infertility, and female pelvic medicine and reconstructive surgery.

But there’s no board certification specifically in MIS, and no requirement for simulation as part of the certification or maintenance of certification process.

And few organizations offer voluntary programs to recognize minimally invasive surgical skills.

The AAGL (formerly the American Association of Gynecologic Laparoscopists) is working on remedying the situation. The AAGL’s Centers of Excellence in Minimally Invasive Gynecologic Surgery is a voluntary designation developed for individuals and institutions.

“The program is still in its early stages, and there has been minimal interest in that kind of certification, but it’s starting to come,” Dr. Glazerman said.

“In an ideal world, certification would require an in-person evaluation at a simulation center,” he said. “At the very least, certification or recertification should entail a review of surgical videos performed by an examiner who reviews the gynecologic surgeon’s procedures.”

Different types of simulation include simple tasks, virtual reality, and team-based simulation.

“We should encourage teamwork among MIS doctors to make sure we are operating on the right patient, with the right equipment, at the right time,” Dr. Glazerman said. “In my opinion, we need to go further than multiple-choice tests. Pilots have to undergo measurement of confidence and competence. We need to minimize confusion and maximize collaboration.”

In recognition of the importance of simulation, the Society of Laparoendoscopic Surgeons is starting a fellowship to train physicians to set up simulation centers, said Dr. Paul Wetter, the Society’s chairman. The first center is under the direction of Dr. Robert Sweet at the University of Minnesota, Minneapolis.

At the Minimally Invasive Surgery Week meeting, presented by the Society of Laparoendoscopic Surgeons and affiliated societies, physicians were trained via simulation on how not to nick the vena cava.

“Now we have the ability to train and check doctors on these simulators. This can be lifesaving,” Dr. Wetter said. “It will happen. We are headed in the right direction.”

NEW YORK – Certification programs for minimally invasive surgery should be more rigorous and continuous, relying on simulation and other hands-on tests of skills, according to Dr. Larry R. Glazerman.

Having rigorous certification could improve the uptake of minimally invasive techniques among patients and encourage insurers to pay for these procedures, he said at the annual Minimally Invasive Surgery Week.

“Right now there is no specific, universally accepted certification in gynecologic laparoscopy. We need certification to go beyond what is currently required. Our certification and recertification standards should confirm competence and confidence,” said Dr. Glazerman, medical director of Planned Parenthood of Delaware.

Several factors contribute to the lack of focus on certification, as well as low uptake of minimally invasive surgery (MIS) by gynecologists. The first is that gynecologists wear “many hats,” he said.

“They serve as primary care doctors, obstetricians, and gynecologists. Also a unique, and negative, feature is that gynecology is the only surgical specialty with a preexisting, ongoing, trusting relationship with the patient. Most gynecologists use traditional surgery, not MIS,” he said.

And gynecologists spend less than half of their training time on surgery, compared with other surgical specialties, he added.

Currently, the American Board of Obstetrics and Gynecology offers certification in obstetrics and gynecology, as well as in the subspecialities of gynecologic oncology, maternal-fetal medicine, reproductive endocrinology and infertility, and female pelvic medicine and reconstructive surgery.

But there’s no board certification specifically in MIS, and no requirement for simulation as part of the certification or maintenance of certification process.

And few organizations offer voluntary programs to recognize minimally invasive surgical skills.

The AAGL (formerly the American Association of Gynecologic Laparoscopists) is working on remedying the situation. The AAGL’s Centers of Excellence in Minimally Invasive Gynecologic Surgery is a voluntary designation developed for individuals and institutions.

“The program is still in its early stages, and there has been minimal interest in that kind of certification, but it’s starting to come,” Dr. Glazerman said.

“In an ideal world, certification would require an in-person evaluation at a simulation center,” he said. “At the very least, certification or recertification should entail a review of surgical videos performed by an examiner who reviews the gynecologic surgeon’s procedures.”

Different types of simulation include simple tasks, virtual reality, and team-based simulation.

“We should encourage teamwork among MIS doctors to make sure we are operating on the right patient, with the right equipment, at the right time,” Dr. Glazerman said. “In my opinion, we need to go further than multiple-choice tests. Pilots have to undergo measurement of confidence and competence. We need to minimize confusion and maximize collaboration.”

In recognition of the importance of simulation, the Society of Laparoendoscopic Surgeons is starting a fellowship to train physicians to set up simulation centers, said Dr. Paul Wetter, the Society’s chairman. The first center is under the direction of Dr. Robert Sweet at the University of Minnesota, Minneapolis.

At the Minimally Invasive Surgery Week meeting, presented by the Society of Laparoendoscopic Surgeons and affiliated societies, physicians were trained via simulation on how not to nick the vena cava.

“Now we have the ability to train and check doctors on these simulators. This can be lifesaving,” Dr. Wetter said. “It will happen. We are headed in the right direction.”

NEW YORK – Certification programs for minimally invasive surgery should be more rigorous and continuous, relying on simulation and other hands-on tests of skills, according to Dr. Larry R. Glazerman.

Having rigorous certification could improve the uptake of minimally invasive techniques among patients and encourage insurers to pay for these procedures, he said at the annual Minimally Invasive Surgery Week.

“Right now there is no specific, universally accepted certification in gynecologic laparoscopy. We need certification to go beyond what is currently required. Our certification and recertification standards should confirm competence and confidence,” said Dr. Glazerman, medical director of Planned Parenthood of Delaware.

Several factors contribute to the lack of focus on certification, as well as low uptake of minimally invasive surgery (MIS) by gynecologists. The first is that gynecologists wear “many hats,” he said.

“They serve as primary care doctors, obstetricians, and gynecologists. Also a unique, and negative, feature is that gynecology is the only surgical specialty with a preexisting, ongoing, trusting relationship with the patient. Most gynecologists use traditional surgery, not MIS,” he said.

And gynecologists spend less than half of their training time on surgery, compared with other surgical specialties, he added.

Currently, the American Board of Obstetrics and Gynecology offers certification in obstetrics and gynecology, as well as in the subspecialities of gynecologic oncology, maternal-fetal medicine, reproductive endocrinology and infertility, and female pelvic medicine and reconstructive surgery.

But there’s no board certification specifically in MIS, and no requirement for simulation as part of the certification or maintenance of certification process.

And few organizations offer voluntary programs to recognize minimally invasive surgical skills.

The AAGL (formerly the American Association of Gynecologic Laparoscopists) is working on remedying the situation. The AAGL’s Centers of Excellence in Minimally Invasive Gynecologic Surgery is a voluntary designation developed for individuals and institutions.

“The program is still in its early stages, and there has been minimal interest in that kind of certification, but it’s starting to come,” Dr. Glazerman said.

“In an ideal world, certification would require an in-person evaluation at a simulation center,” he said. “At the very least, certification or recertification should entail a review of surgical videos performed by an examiner who reviews the gynecologic surgeon’s procedures.”

Different types of simulation include simple tasks, virtual reality, and team-based simulation.

“We should encourage teamwork among MIS doctors to make sure we are operating on the right patient, with the right equipment, at the right time,” Dr. Glazerman said. “In my opinion, we need to go further than multiple-choice tests. Pilots have to undergo measurement of confidence and competence. We need to minimize confusion and maximize collaboration.”

In recognition of the importance of simulation, the Society of Laparoendoscopic Surgeons is starting a fellowship to train physicians to set up simulation centers, said Dr. Paul Wetter, the Society’s chairman. The first center is under the direction of Dr. Robert Sweet at the University of Minnesota, Minneapolis.

At the Minimally Invasive Surgery Week meeting, presented by the Society of Laparoendoscopic Surgeons and affiliated societies, physicians were trained via simulation on how not to nick the vena cava.

“Now we have the ability to train and check doctors on these simulators. This can be lifesaving,” Dr. Wetter said. “It will happen. We are headed in the right direction.”

NEW YORK – Uterine size does not appear to increase the risk of surgical complications in patients who undergo type VII total laparoscopic hysterectomy, but both uterine size and the number of prior pelvic surgeries increased surgical time in a linear manner, according to a retrospective case-control analysis.

“There is insufficient evidence to determine a statistical correlation between uterine size and presence of surgical complications. Therefore, type VII [total laparoscopic hysterectomy] seems to be a feasible and safe surgical procedure, resulting in a short hospital stay, minimal blood loss, minimal operating time, and a low complication rate regardless of uterine weight,” Dr. Carlos Hernández Nieto said at the annual Minimally Invasive Surgery Week.

Type VII total laparoscopic hysterectomy consists of completing all surgical dissection, ligations, and sutures through trocars, including vaginal closure.

©Thinkstock.com

The study was based on 235 consecutive patients undergoing type VII total laparoscopic hysterectomy at two hospitals between January 2008 and December 2014. Sufficient information was available on 211 patients.

The mean age of women in the study was 45 years, with a mean body mass index of 25.3 kg/m². The mean number of prior births was two; the mean number of prior pelvic surgeries was two; the mean number of days in hospital was three; the mean surgical time was 140 minutes; and the mean uterine weight was 142 grams. Mean blood loss during surgery was 100 cc.

Surgical complications occurred in 14 patients (6.6%); two had bleeding which led to conversion to laparotomy and 12 had fever. The mean uterine weight in the group with complications was 161.8 grams, according to Dr. Hernández Nieto of TEC Salud Health Care System, Monterrey, Mexico.

A logistical regression analysis showed that the only factor significantly related to complications was the mean surgical time (170 minutes in this group of patients; P = .003). Uterine weight was not significantly related to complications.

Uterine weight was, however, significantly associated with increased surgical time. Surgical time increased from 0.02 to 1 minute for each additional gram of weight (P = .002), Dr. Hernández Nieto said. The number of prior pelvic surgeries also significantly increased surgical time. For each prior pelvic surgery, surgical time increased from 1.62 to 8.72 minutes (P = .006).

Dr. Hernández Nieto reported having no financial disclosures.

NEW YORK – Uterine size does not appear to increase the risk of surgical complications in patients who undergo type VII total laparoscopic hysterectomy, but both uterine size and the number of prior pelvic surgeries increased surgical time in a linear manner, according to a retrospective case-control analysis.

“There is insufficient evidence to determine a statistical correlation between uterine size and presence of surgical complications. Therefore, type VII [total laparoscopic hysterectomy] seems to be a feasible and safe surgical procedure, resulting in a short hospital stay, minimal blood loss, minimal operating time, and a low complication rate regardless of uterine weight,” Dr. Carlos Hernández Nieto said at the annual Minimally Invasive Surgery Week.

Type VII total laparoscopic hysterectomy consists of completing all surgical dissection, ligations, and sutures through trocars, including vaginal closure.

©Thinkstock.com

The study was based on 235 consecutive patients undergoing type VII total laparoscopic hysterectomy at two hospitals between January 2008 and December 2014. Sufficient information was available on 211 patients.

The mean age of women in the study was 45 years, with a mean body mass index of 25.3 kg/m². The mean number of prior births was two; the mean number of prior pelvic surgeries was two; the mean number of days in hospital was three; the mean surgical time was 140 minutes; and the mean uterine weight was 142 grams. Mean blood loss during surgery was 100 cc.

Surgical complications occurred in 14 patients (6.6%); two had bleeding which led to conversion to laparotomy and 12 had fever. The mean uterine weight in the group with complications was 161.8 grams, according to Dr. Hernández Nieto of TEC Salud Health Care System, Monterrey, Mexico.

A logistical regression analysis showed that the only factor significantly related to complications was the mean surgical time (170 minutes in this group of patients; P = .003). Uterine weight was not significantly related to complications.

Uterine weight was, however, significantly associated with increased surgical time. Surgical time increased from 0.02 to 1 minute for each additional gram of weight (P = .002), Dr. Hernández Nieto said. The number of prior pelvic surgeries also significantly increased surgical time. For each prior pelvic surgery, surgical time increased from 1.62 to 8.72 minutes (P = .006).

Dr. Hernández Nieto reported having no financial disclosures.

NEW YORK – Uterine size does not appear to increase the risk of surgical complications in patients who undergo type VII total laparoscopic hysterectomy, but both uterine size and the number of prior pelvic surgeries increased surgical time in a linear manner, according to a retrospective case-control analysis.

“There is insufficient evidence to determine a statistical correlation between uterine size and presence of surgical complications. Therefore, type VII [total laparoscopic hysterectomy] seems to be a feasible and safe surgical procedure, resulting in a short hospital stay, minimal blood loss, minimal operating time, and a low complication rate regardless of uterine weight,” Dr. Carlos Hernández Nieto said at the annual Minimally Invasive Surgery Week.

Type VII total laparoscopic hysterectomy consists of completing all surgical dissection, ligations, and sutures through trocars, including vaginal closure.

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The study was based on 235 consecutive patients undergoing type VII total laparoscopic hysterectomy at two hospitals between January 2008 and December 2014. Sufficient information was available on 211 patients.

The mean age of women in the study was 45 years, with a mean body mass index of 25.3 kg/m². The mean number of prior births was two; the mean number of prior pelvic surgeries was two; the mean number of days in hospital was three; the mean surgical time was 140 minutes; and the mean uterine weight was 142 grams. Mean blood loss during surgery was 100 cc.

Surgical complications occurred in 14 patients (6.6%); two had bleeding which led to conversion to laparotomy and 12 had fever. The mean uterine weight in the group with complications was 161.8 grams, according to Dr. Hernández Nieto of TEC Salud Health Care System, Monterrey, Mexico.

A logistical regression analysis showed that the only factor significantly related to complications was the mean surgical time (170 minutes in this group of patients; P = .003). Uterine weight was not significantly related to complications.

Uterine weight was, however, significantly associated with increased surgical time. Surgical time increased from 0.02 to 1 minute for each additional gram of weight (P = .002), Dr. Hernández Nieto said. The number of prior pelvic surgeries also significantly increased surgical time. For each prior pelvic surgery, surgical time increased from 1.62 to 8.72 minutes (P = .006).

Dr. Hernández Nieto reported having no financial disclosures.

NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.

But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.

“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”

Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.

Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.

A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.

So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.

“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.

Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.

“I have stopped using electric morcellation, and now we use a bag,” he said.

Dr. Nezhat reported having no relevant financial disclosures.

NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.

But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.

“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”

Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.

Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.

A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.

So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.

“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.

Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.

“I have stopped using electric morcellation, and now we use a bag,” he said.

Dr. Nezhat reported having no relevant financial disclosures.

NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.

But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.

“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”

Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.

Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.

A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.

So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.

“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.

Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.

“I have stopped using electric morcellation, and now we use a bag,” he said.

Dr. Nezhat reported having no relevant financial disclosures.

NEW YORK – While some evidence in the surgical literature suggests that intraperitoneal bupivacaine reduces postoperative pain scores and narcotic use, a new randomized controlled trial shows no significant improvement in patients undergoing robot-assisted total laparoscopic hysterectomy.

“Despite evidence of benefit in laparoscopic surgery, there does not appear to be a benefit for using intraperitoneal bupivacaine. We need a larger sample size to study this,” Dr. Allan Klapper said at the annual Minimally Invasive Surgery Week.

The uptake of robot-assisted total laparoscopic hysterectomy increased by 9.5% in the United States, and hospitals with robotic capabilities perform 22.4% of hysterectomies with this technique, according to Dr. Klapper, an ob.gyn. at West Pennsylvania Allegheny Health System in Pittsburgh. Minimally invasive surgery, however, does not completely eliminate postoperative pain, and between one-third and two-thirds of patients report pain following such surgery.

Intraperitoneal bupivacaine (IB) was selected for the study because of positive reports in small studies of patients undergoing laparoscopic cholecystectomy and gynecologic procedures, Dr. Klapper explained. He noted that the positive studies were of poor quality, but other studies – also of poor quality – had negative results.

To investigate the role of IB in reducing postoperative pain and narcotic requirements in patients undergoing robot-assisted total laparoscopic hysterectomy, Dr. Klapper and his colleagues launched a prospective, double-blind, randomized, placebo-controlled trial comparing IB to normal saline in 41 patients managed with a standardized postoperative analgesic regimen.

Baseline characteristics showed no differences between the two groups in surgical indications, body mass index, operating room time, number of previous surgeries, and the percentage of patients undergoing lymph node dissection. Patients were excluded from the analysis if they converted to laparotomy, were allergic to IB, or were currently on treatment for chronic pain.

Complete data on pain response, as assessed by the visual analog scale, was available for 29 of the 41 patients. No significant differences in postoperative pain scores were observed between the two groups at 1, 16, 18, and 24 hours. Further, there was no significant difference in morphine dose between the IB and normal saline groups.

“One finding was the opposite of what I would have expected. Patients who underwent lymph node dissection used significantly less narcotic analgesic [P = .03],” Dr. Klapper told the audience.

Study strengths were the prospective, randomized design, and its being adequately powered to detect a significant difference between the two groups. But the study was conducted at a single institution and did not include data beyond 24 hours. Also, Dr. Klapper said that perhaps results should have been stratified according to indications for surgery.

“There is more and more pressure on us to achieve higher patient satisfaction scores. Soon down the line, patient satisfaction will become a metric for compensation. We need to focus on what we can do to improve patient satisfaction scores and experience,” Dr. Klapper said. “A larger sample of gynecologic oncology patients is needed to further support these conclusions, and we need to fine tune to avoid the problems in this study.”

The meeting was presented by the Society of Laparoendoscopic Surgeons and affiliated societies. Dr. Klapper reported that he is on the speakers bureau for Astellas.

NEW YORK – While some evidence in the surgical literature suggests that intraperitoneal bupivacaine reduces postoperative pain scores and narcotic use, a new randomized controlled trial shows no significant improvement in patients undergoing robot-assisted total laparoscopic hysterectomy.

“Despite evidence of benefit in laparoscopic surgery, there does not appear to be a benefit for using intraperitoneal bupivacaine. We need a larger sample size to study this,” Dr. Allan Klapper said at the annual Minimally Invasive Surgery Week.

The uptake of robot-assisted total laparoscopic hysterectomy increased by 9.5% in the United States, and hospitals with robotic capabilities perform 22.4% of hysterectomies with this technique, according to Dr. Klapper, an ob.gyn. at West Pennsylvania Allegheny Health System in Pittsburgh. Minimally invasive surgery, however, does not completely eliminate postoperative pain, and between one-third and two-thirds of patients report pain following such surgery.

Intraperitoneal bupivacaine (IB) was selected for the study because of positive reports in small studies of patients undergoing laparoscopic cholecystectomy and gynecologic procedures, Dr. Klapper explained. He noted that the positive studies were of poor quality, but other studies – also of poor quality – had negative results.

To investigate the role of IB in reducing postoperative pain and narcotic requirements in patients undergoing robot-assisted total laparoscopic hysterectomy, Dr. Klapper and his colleagues launched a prospective, double-blind, randomized, placebo-controlled trial comparing IB to normal saline in 41 patients managed with a standardized postoperative analgesic regimen.

Baseline characteristics showed no differences between the two groups in surgical indications, body mass index, operating room time, number of previous surgeries, and the percentage of patients undergoing lymph node dissection. Patients were excluded from the analysis if they converted to laparotomy, were allergic to IB, or were currently on treatment for chronic pain.

Complete data on pain response, as assessed by the visual analog scale, was available for 29 of the 41 patients. No significant differences in postoperative pain scores were observed between the two groups at 1, 16, 18, and 24 hours. Further, there was no significant difference in morphine dose between the IB and normal saline groups.

“One finding was the opposite of what I would have expected. Patients who underwent lymph node dissection used significantly less narcotic analgesic [P = .03],” Dr. Klapper told the audience.

Study strengths were the prospective, randomized design, and its being adequately powered to detect a significant difference between the two groups. But the study was conducted at a single institution and did not include data beyond 24 hours. Also, Dr. Klapper said that perhaps results should have been stratified according to indications for surgery.

“There is more and more pressure on us to achieve higher patient satisfaction scores. Soon down the line, patient satisfaction will become a metric for compensation. We need to focus on what we can do to improve patient satisfaction scores and experience,” Dr. Klapper said. “A larger sample of gynecologic oncology patients is needed to further support these conclusions, and we need to fine tune to avoid the problems in this study.”

The meeting was presented by the Society of Laparoendoscopic Surgeons and affiliated societies. Dr. Klapper reported that he is on the speakers bureau for Astellas.

NEW YORK – While some evidence in the surgical literature suggests that intraperitoneal bupivacaine reduces postoperative pain scores and narcotic use, a new randomized controlled trial shows no significant improvement in patients undergoing robot-assisted total laparoscopic hysterectomy.

“Despite evidence of benefit in laparoscopic surgery, there does not appear to be a benefit for using intraperitoneal bupivacaine. We need a larger sample size to study this,” Dr. Allan Klapper said at the annual Minimally Invasive Surgery Week.

The uptake of robot-assisted total laparoscopic hysterectomy increased by 9.5% in the United States, and hospitals with robotic capabilities perform 22.4% of hysterectomies with this technique, according to Dr. Klapper, an ob.gyn. at West Pennsylvania Allegheny Health System in Pittsburgh. Minimally invasive surgery, however, does not completely eliminate postoperative pain, and between one-third and two-thirds of patients report pain following such surgery.

Intraperitoneal bupivacaine (IB) was selected for the study because of positive reports in small studies of patients undergoing laparoscopic cholecystectomy and gynecologic procedures, Dr. Klapper explained. He noted that the positive studies were of poor quality, but other studies – also of poor quality – had negative results.

To investigate the role of IB in reducing postoperative pain and narcotic requirements in patients undergoing robot-assisted total laparoscopic hysterectomy, Dr. Klapper and his colleagues launched a prospective, double-blind, randomized, placebo-controlled trial comparing IB to normal saline in 41 patients managed with a standardized postoperative analgesic regimen.

Baseline characteristics showed no differences between the two groups in surgical indications, body mass index, operating room time, number of previous surgeries, and the percentage of patients undergoing lymph node dissection. Patients were excluded from the analysis if they converted to laparotomy, were allergic to IB, or were currently on treatment for chronic pain.

Complete data on pain response, as assessed by the visual analog scale, was available for 29 of the 41 patients. No significant differences in postoperative pain scores were observed between the two groups at 1, 16, 18, and 24 hours. Further, there was no significant difference in morphine dose between the IB and normal saline groups.

“One finding was the opposite of what I would have expected. Patients who underwent lymph node dissection used significantly less narcotic analgesic [P = .03],” Dr. Klapper told the audience.

Study strengths were the prospective, randomized design, and its being adequately powered to detect a significant difference between the two groups. But the study was conducted at a single institution and did not include data beyond 24 hours. Also, Dr. Klapper said that perhaps results should have been stratified according to indications for surgery.

“There is more and more pressure on us to achieve higher patient satisfaction scores. Soon down the line, patient satisfaction will become a metric for compensation. We need to focus on what we can do to improve patient satisfaction scores and experience,” Dr. Klapper said. “A larger sample of gynecologic oncology patients is needed to further support these conclusions, and we need to fine tune to avoid the problems in this study.”

The meeting was presented by the Society of Laparoendoscopic Surgeons and affiliated societies. Dr. Klapper reported that he is on the speakers bureau for Astellas.

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

NEW YORK – Cryoablation of the endometrium is a safe and effective office-based procedure for the treatment of menorrhagia, resulting in few operative complications, according to a chart review of 100 consecutive cases over a 3-year period.

“Abnormal uterine bleeding is the most common reason for referral to a gynecologist, and it is associated with an adverse impact on quality of life, health care use, and cost. Hysterectomy cures abnormal uterine bleeding, but surgery has risks,” study author Dr. Radha Syed said at the annual Minimally Invasive Surgery Week.

Between 2012 and 2015, Dr. Syed treated women aged 37-51 years with cryoablation of the endometrium under ultrasound guidance in her office. Anesthesia was provided by intravenous conscious sedation and paracervical blocks. Manufacturer’s guidelines were followed for the procedure, with voice prompts from the generator device, said Dr. Syed of the North Shore LIJ Health System, Staten Island, N.Y.

Indications for cryoablation included refractory menorrhagia or menorrhagia affecting quality of life with benign etiology; patients who did not want hysterectomy were not operative candidates.

Patient-based outcome measures were used to assess results of cryoablation. In the recovery room, pain scores were between 2 and 3, as assessed by a visual analog scale ranging from 0 to 10, with 10 signifying the most severe pain. Patients were able to return to work on the first or second postoperative day.

There were no intraoperative or immediate postoperative complications among the 100 consecutive cases reviewed. The maximum follow-up time was 36 months.

The most pressing postoperative symptom was excess watery discharge lasting 2-3 weeks, which was sometimes bloody, Dr. Syed said at the meeting, which was presented by the Society of Laparoendoscopic Surgeons and affiliated societies.

Delayed complications included two hematometra due to cervical cicatrix 4-6 weeks from surgery, which was managed by dilation under ultrasound guidance. One to two years after surgery, two patients underwent hysterectomy for recurrence of menorrhagia; both were associated with fibroids.

Patient satisfaction was 90%, as assessed over the phone using patient-based outcome measures. Most patients achieved hypomenorrhea or eumenorrhea. The rate of amenorrhea was less than 30%.

“Other minimally invasive procedures are available, but it is difficult to compare these procedures due to the subjective nature of complaints and variable symptoms,” Dr. Syed said. “I find cryoablation useful. There is less pain than with hysterectomy, and patient satisfaction is high. Even though the equipment is expensive, cryoablation avoids hysterectomy and all its attendant risks.”

Dr. Syed reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.