Surgical Skills Across the Spectrum: Comparing Surgical Skill Based on Surgical Experience Using a Standardized, High-Fidelity Total Laparoscopic Hysterectomy Model

Abstract

Study Objective To determine differences in surgical skills and confidence in the completion of a standardized total laparoscopic hysterectomy (TLH) between Ob-Gyns with different levels of training and expertise. Design Prospective, single-blinded, case-control study. Setting Simulated operating room. Patients or Participants Four categories of Ob-Gyns: (1) graduating residents (n=13), (2) graduating FMIGS fellows (n=11), (3) generalists (n=15), and (4) fellowship-trained MIGS specialists (n=19), totaling 58 participants. Interventions All participants completed pre-simulation questionnaires assessing laparoscopic surgical confidence. They then performed a video-recorded TLH on a standardized 250 gram novel biologic model developed by Gynesim and completed a post-simulation questionnaire. Measurements and Main Results The procedures were randomized and scored by blinded expert reviewers in MIGS and Gynecology Oncology using the validated Objective Structured Assessment of Technical Skills (OSATS). The surgery was divided into 5 standardized segments: (1) adnexa, (2) broad ligament, bladder flap, vascular pedicles, (3) colpotomy, (4) cuff closure, and (5) tissue extraction. Highest score = 35. Specialists (average 8.9 years in practice) scored highest in all categories (mean scores 30.95, 31.16, 32.21, 31.37 and 33.26, respectively [p Conclusion When performing a TLH on a standardized 250g uterus, fellowship-trained experts achieved higher OSATS in all areas and completed all procedural components faster. Recent MIGS fellowship graduates performed similarly to generalists practicing an average of 20 years.