American Association Of Gynecologic Laparoscopists Research Articles

Evaluating the Quality of Endometriosis Operative Reports Among High-Volume Endometriosis Surgeons

ObjectivesTo evaluate the quality of operative reports for endometriosis surgeries performed by fellowship-trained, high-volume endometriosis surgeons. MethodsIn this retrospective review, 5 consecutive deidentified surgical reports per surgeon were evaluated by 2 reviewers. Each dictation was assigned a quality score (between 0 and 28), based on the number of components from the American Association of Gynecologic Laparoscopists (AAGL) classification system that were documented. The primary outcome was the proportion of reports for which the endometriosis AAGL 2021 stage could be assigned. Secondary outcomes included median dictation quality scores, proportion of dictations for fertility-preserving cases where the Endometriosis Fertility Index score could be assigned, individual quality score components, and quality score variation between surgeons, institutions, and reporting methods. ResultsOverall, 82 operative reports were reviewed from 16 surgeons across 7 sites in Ontario. The AAGL stage could be assigned in 48/82 (59%) of cases, and the Endometriosis Fertility Index score could be assigned in 31/45 of fertility-preserving cases (69%). The median quality score was 57% (range 18%–86%). Only 13% of operative reports included comments on residual disease. Quality score consistency between reports was poor for a given surgeon (intraclass correlation coefficient 0.22; 95% CI 0.03–0.49). Quality scores differed significantly between surgeons (χ2 = 30.6, df = 16, P = 0.015) and institutions (χ2 = 19.59, df = 7, P = 0.007). Operative report quality score did not differ based on completion by trainee or staff, template use, or whether the report was completed by telephone or typed. ConclusionsThere is significant variability and inconsistency in endometriosis surgery documentation. There is a need to standardize surgical documentation for endometriosis surgeries, enhancing communication and ultimately patient care.

Enhanced Recovery After Surgery (ERAS) Practices in Minimally Invasive Gynaecologic Surgery: A National Survey

ObjectivesEnhanced recovery after surgery (ERAS) pathways are evidence-based practices that minimize perioperative physiologic stress, reducing postoperative complications and recovery time. This study assessed the Canadian application of, and adherence to, ERAS recommendations during minimally invasive gynaecologic surgery, and identified barriers to ERAS uptake. MethodsA self-administered cross-sectional survey was distributed to obstetrics and gynaecology residents, fellows, and attendings through 3 national listservs from February 2021 to January 2022. The survey assessed 14 perioperative components per the American Association of Gynecologic Laparoscopists ERAS consensus guidelines. Two study groups were defined—participants with versus without an established ERAS program—and comparison analyses as well as inferential statistical tests were performed. ResultsOverall, 158 responses were analyzed. A total of 41.9% of respondents work in a centre with an ERAS program. Adherence to ERAS recommendations was high with engaging patients in the operative processes, changing equipment after a contaminated procedure, discontinuing urinary catheters, and initiating early postoperative mobilization. ERAS programming enhanced adherence to preoperative carbohydrate loading, intraoperative fluid management, normothermia, and bowel-regimen adjuncts (P < 0.05). Despite ERAS programming, adherence to some recommendations—preoperative fasting, and comorbidity optimization—remained low. Most respondents felt that ERAS is safe (98%) and improves outcomes (82%). ConclusionsWhile the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners across Canada engage in various ERAS components. ERAS program sites had higher adherence to some perioperative recommendations; however, some high-level evidence recommendations still have national adherence gaps. Targeted research around low-adherence components would help identify and address barriers to optimizing surgical care.

Inter-observer reproducibility of the 2021 AAGL Endometriosis Classification.

Inter-observer agreement for the American Association of Gynecologic Laparoscopists (AAGL) 2021 Endometriosis Classification staging system has not been described. Its predecessor staging system, the revised American Society for Reproductive Medicine (rASRM), has historically demonstrated poor inter-observer agreement. We aimed to determine the inter-observer agreement performance of the AAGL 2021 Endometriosis Classification staging system, and compare this with the rASRM staging system. A database of 317 patients with coded surgical data was retrospectively analysed. Three independent observers allocated AAGL surgical stages (1-4), twice. Observers made their own interpretation of how to apply the tool in the first staging allocation. Consensus rules were then developed for a second staging allocation. First staging allocation: odds ratio (OR) (and 95% CI) for observer 1 to score higher than observer 2 was 8.08 (5.12-12.76). Observer 1 to score higher than observer 3 was 12.98 (7.99-21.11) and observer 2 to score higher than observer 3 was 1.61 (1.03-2.51). This represents poor agreement. Second staging allocation (after consensus): OR for observer 1 to score higher than observer 2 was 1.14 (0.64-2.03), observer 1 to score higher than observer 3 was 1.81 (0.99-3.28) and observer 2 to score higher than observer 3 was 1.59 (0.87-2.89). This represents good agreement. These findings suggest that in its current format the AAGL 2021 Endometriosis Classification staging system has poor inter-observer agreement, not superior to the rASRM staging system. However, performance improved when additional measures were taken to simplify and clarify areas of ambiguity in interpreting the staging system.

Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: An International Consensus Statement

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval.Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies.This Consensus Statement should be cited as: ‘G. Condous, B. Gerges, I. Thomassin-Naggara, C. Becker, C. Tomassetti, H. Krentel, B.J. van Herendael, M. Malzoni, M. S. Abrao, E. Saridogan, J. Keckstein, G. Hudelist and Collaborators. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: An International Consensus Statement. Eur. J. Radiol. 2024. https://doi.org/10.1016/j.ejrad.2024.111450.’

Non-Invasive Imaging Techniques for Diagnosis of Pelvic Deep Endometriosis and Endometriosis Classification Systems: An International Consensus Statement

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies.

Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement.

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies. © 2024 The Authors. Published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology, by Universa Press, by The International Society for Gynecologic Endoscopy, by Oxford University Press on behalf of European Society of Human Reproduction and Embryology, by Elsevier Inc. on behalf of American Association of Gynecologic Laparoscopists and by Elsevier B.V.

Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement.

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers, and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling, and planning of surgical treatment strategies.

Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology

Unlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known. To systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties. A systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes. A total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention. This study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment.

Preoperative Counseling and Surgical Practice: Gynecologic Surgeons' Approach to Ovary-Sparing Hysterectomy [ID 2683432

INTRODUCTION: Since the early 20th century, surgical practices on prophylactic oophorectomy at the time of hysterectomy have fluctuated. This study aims to assess how current gynecologic surgeons are counseling patients on ovary-sparing benign hysterectomies and assess any gaps in provider knowledge. METHODS: Institutional review board exception was obtained. A survey was piloted and underwent several rounds of editing before being sent to members of American Association of Gynecologic Laparoscopists (AAGL) in April 2023. The questionnaire evaluated preoperative counseling on risks and benefits of ovary-sparing hysterectomy for benign indications and surgical practices for when to perform bilateral salpingectomy and oophorectomy. Descriptive statistics and regression analyses were performed. RESULTS: The survey was sent out by email to 6,622 AAGL members, 3,576 opened the email, and 520 completed surveys (14% response rate). Approximately one-half (58%) completed subspeciality training. Most counsel patients on the benefits of ovarian conservation including the prevention of osteoporosis (88%), early onset menopause (87%), cardiovascular disease (84%), and dementia (52%). Fifty percent recommend routine bilateral salpingo-oophorectomy at time of hysterectomy starting at age 61, whereas 38% recommend this be performed at age 51–55 years. CONCLUSION: Gynecologic surgeons are counseling patients on the risks and benefits of ovarian conservation. How frequently ovary-sparing hysterectomies are offered and the age at which bilateral salpingo-oophorectomy is recommended vary by provider. Additional high-quality studies are needed to further understand the optimal timing of oophorectomy at time of benign hysterectomy, and there is also a need for provider education to minimize discrepancy in practice patterns.

Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement†,‡.

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on a review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling and planning of surgical treatment strategies.

External Validation of the “2021 AAGL Endometriosis Classification”: A Retrospective Cohort Study

Externally validate the American Association of Gynecologic Laparoscopists (AAGL) staging system against surgical complexity and compare diagnostic accuracy with revised American Society for Reproductive Medicine (rASRM) stage, as was done in original publication. Retrospective, diagnostic accuracy study. Multicenter (Sydney, Australia). A total of 317 patients (January 2016-October 2021) were used in the final analysis. A database of patients with coded surgical data was analyzed. Three independent observers assigned an AAGL surgical stage (1-4) as the index test and surgical complexity level (A-D) as the reference standard. Results from the most accurate of the 3 observers were used in the final analysis. The weighted kappa score for the overall performance of AAGL stage and rASRM to predict AAGL level was 0.48 and 0.48, respectively (no difference). This represents weaker agreement with AAGL level than was observed in the reference paper, which reported a weighted kappa of 0.62. Diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) for stage 1 to predict level A was 98.5%, 64.3%, 66.3%, and 98.3%; stage 2 to predict level B 31.2%, 90.5%, 27.0%, and 92.1 %; stage 3 to predict level C 12.3%, 94.1%, 59.3%, and 60.7%; stage 4 to predict level D 95.65%, 88.10%, 38.60%, and 99.62%. Area under the receiver operating characteristic curve for A vs B/C/D (cut point 9) was 0.87, A/B vs C/D (cut point 16) was 0.78, and A/B/C vs D (cut point 22) was 0.94. There was weak to moderate agreement between AAGL stage and AAGL surgical complexity level. Across all key indicators, the AAGL system did not perform as well in this external validation, nor did it outperform rASRM as it did in the reference paper. Results suggest the system is not generalizable.

Gynecologic Surgical Training: Current and Future Perspectives

Gynecologic Surgical Training: Current and Future Perspectives

Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced Stages

To compare the accuracy of preoperative ultrasound (US) in predicting the laparoscopically defined 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Staging. Retrospective multicenter study of patients treated at 3 specialized endometriosis centers. Three specialized endometriosis surgical centers in São Paulo (Brazil), Barcelona (Spain), and Avellino (Italy) participated. A total of 878 patients aged 15 to 45 years with no history of pelvic malignancy underwent laparoscopic (LPS) treatment for suspected endometriosis. Retrospective review of preoperative transvaginal and transabdominal US (index test) assessed for endometriosis at all sites used in the 2021 AAGL Endometriosis Classification and classified patients into AAGL-US stages 1 to 4. Results were compared with reference-standard LPS (AAGL-LPS) staging. The AAGL-US and AAGL-LPS stage were concordant in 586 cases (66.7%) (weighted kappa [WK] 0.759; intraclass correlation=0.906), with the highest agreement observed in patients with no endometriosis (n=70, 75.3% concordance), AAGL-LPS stage 1 (104, 50.7%) and stage 4 disease (358, 88.2%). Endometriosis was most accurately diagnosed in the rectum/sigmoid colon (WK 0.862), bladder (WK 0.911), and ovaries (WK 0.835/0.795 for right/left, respectively) and least accurately diagnosed at superficial peritoneal (WK 0.442), tubal (WK 0.391/0.363 for right/left, respectively), and retrocervical/uterosacral ligament (WK 0.656) sites. Sonographic estimation of the 2021 AAGL Endometriosis Staging is greatest in AAGL-LPS stages 1 and 4 and among patients with no endometriosis. US best identifies endometriosis of the ovaries, bladder, and bowel but is more limited for the tubes and superficial peritoneum.

7919 External Validation of the Recently Published “Aagl 2021 Endometriosis Classification” Staging System

<h3>Study Objective</h3> We aim to externally validate the "2021 AAGL Endometriosis Classification" system. <h3>Design</h3> A multicenter, retrospective, diagnostic accuracy study. <h3>Setting</h3> 2 gynecology units in metropolitan Sydney, Australia. <h3>Patients or Participants</h3> Patients with suspected endometriosis who underwent laparoscopy between January 2016 and October 2021 (n=272). <h3>Interventions</h3> Databases from three previous research studies were examined. Patients with comprehensive coded surgical data were identified. All patients were staged surgically by three assessors, according to the 2021 American Association of Gynecologic Laparoscopists (AAGL) classification staging tool. The AAGL 4-level surgical complexity scale was used as the validation tool. <h3>Measurements and Main Results</h3> 272 surgical cases were analyzed. Breakdown of surgical complexity levels were as follows: A 149 (54.8%), B 23 (8.5%), C 80 (29.4%) and D (20 (7.4%). The diagnostic accuracy for all observers to predict each level in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were: stage 1 to predict level A = 97.9-98.7%, 60.2-64.2%, 75.0-76.9% & 96.3-97.5%; stage 2 to predict level B = 26.1-30.4%, 93.2-95.6%, 26.3-35.3% & 92.9-93.6%; stage 3 to predict level C = 7.5-10.0%, 93.8-94.8%, 33.3-42.1% & 70.9-71.5%; stage 4 to predict level D = 90.-95.0%, 90.1-91.7% &, 41.9-47.5% & 99.1-99.6%. For all three assessors, AUROC for A vs B/C/D (cut-point 9) 0.75-0.88, A/B vs C/D (cut-point 16) 0.81 and A/B/C vs D (cut-point 22) 0.95-0.96. <h3>Conclusion</h3> This external validation study demonstrates that the highest AAGL stage performs reasonably well for the prediction of surgical complexity, albeit with low NPV. However, the three lower stages perform poorly. The AUROC scores for AAGL stage to discriminate surgical complexity levels was less promising than in the original publication of the staging tool. This is the first external validation study of the AAGL 2021 classification system. The results suggest that in its current form, it is not generalizable.

7943 Modification of the “Aagl Endometriosis Classification” to a 3-Stage System: Diagnostic Accuracy & Inter-Observer Reproducibility Study

<h3>Study Objective</h3> We aim to assess the performance of a modified AAGL (mAAGL) endometriosis classification system and its inter-observer reproducibility. <h3>Design</h3> Retrospective diagnostic accuracy & inter-observer reproducibility study. <h3>Setting</h3> 2 gynecology units in metropolitan Sydney, Australia. <h3>Patients or Participants</h3> Patients with suspected endometriosis who underwent laparoscopy between January 2016 and October 2021 (n=272). <h3>Interventions</h3> Patients with complete surgical data included. The original 4-stage American Association of Gynecologic Laparoscopists (AAGL) staging system was modified to three stages by merging AAGL stages 2 and 3 and surgical complexity levels B and C. Three observers independently apportioned an AAGL stage 1-3, blinded to surgical skill level (A, B and C). End points were diagnostic performance of each observer to predict level of surgical complexity for each stage, i.e., mAAGL stage 1 to predict level A, mAAGL stage 2 to predict level B, mAAGL stage 3 to predict level C. Inter-observer reproducibility was assessed using OR of a higher grade, between each pair of observers. <h3>Measurements and Main Results</h3> 272 surgical cases analyzed. The diagnostic accuracy for all observers to predict each level in terms of sensitivity, specificity, PPV and NPV were: stage 1 to predict level A: 98.0-98.7%, 60.2-64.2%, 75.0-76.9% & 96.3-97.5%; stage 2 to predict level B: 31.1-36.9%, 97.0-98.2%, 86.5-92.6% & 69.8 – 71.9%; stage 3 to predict level C: 90.0-95.0%, 90.1-91.7%, 41.8 - 47.5% & 99.1-99.6%. Inter-observer reproducibility between observer 1 & 2 was 0.81, between observer 1 & 3 was 0.69 and between observer 2 & 3 was 0.43. Overall percentage agreement between observers 1 & 2 was 93.4%, between 1 & 3 was 93.4% & between 2 & 3 was 96.3%. <h3>Conclusion</h3> The mAAGL system appears to perform well for both low and high stage endometriosis disease. The 4-stage AAGL staging system could be improved by merging AAGL stages 2 and 3 and in turn using a 3-stage system.

Enhanced Recovery after Surgery (ERAS) Practices in Minimally Invasive Gynecologic Surgery: A National Survey

<h3>Study Objective</h3> Enhanced Recovery After Surgery (ERAS) pathways are evidence-based practices aimed at minimizing perioperative physiologic stress responses. This reduces recovery time, hospital-stay length, postoperative complications, and hospital cost per patient. The objective of this study was to assess the Canadian application of and adherence to ERAS protocols during minimally invasive gynecologic surgery. We also aimed to identify facilitators and barriers to ERAS uptake in our population. <h3>Design</h3> A self-administered cross-sectional survey was distributed via three listservs (Canadian Ob/Gyn residency programs, CanSAGE, and the Society of Obstetricians and Gynecologists of Canada [SOGC]) between February 2021 to January 2022. The survey assessed 14 perioperative components as per the American Association of Gynecologic Laparoscopists (AAGL) ERAS consensus guidelines. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Canadian Ob/Gyn residents, fellows, and attendings. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> 157 responses were analyzed. Majority of respondents (77%) are attendings and work in academic hospitals (48%). Only 41% of respondents work within an established ERAS program. Majority of respondents engage in preoperative anemia optimization, although targets varied with 43% targeting Hemoglobin>120g/L. The proportion of respondents that engaged in other preoperative interventions (e.g., lifestyle modification) varied. While most counselled on hyperglycemia and obstructive sleep apnea, a smaller proportion (16-39%) addressed obesity, smoking cessation, and alcohol intake; notably, this was consistent across sites with and without established ERAS programs. Respondents had a high adherence to intraoperative practices including VTE prophylaxis (83%), early feeding (98%), and early ambulation (89%). There was poor adherence to perioperative fasting times, preoperative carbohydrate loading, and intraoperative IV fluids. Most respondents felt ERAS pathways were safe (98%) and improved patient outcomes (82%). <h3>Conclusion</h3> While the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners engage in various ERAS components as per consensus guidelines. Future and targeted research around ERAS components with lower adherence would be beneficial in identifying and addressing barriers to optimize surgical care.

8117 OB/GYN Clinician Training in Addressing Sexual Trauma

<h3>Study Objective</h3> To assess OB/GYN clinicians' prior training in screening and discussing sexual trauma (ST) with patients as well as preferences for future training modalities. <h3>Design</h3> A 50-item questionnaire was distributed electronically. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> 129 practicing OB/GYN members of the American Association of Gynecologic Laparoscopists or the International Pelvic Pain Society were surveyed. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Although 93.8% of participants believed discussing ST is part of their role as a clinician, fewer participants (69.8%) reported that they routinely screen patients for a history of ST in practice. Lack of relevant training was a commonly cited barrier to such discussions, with only 44.2% of the total cohort reporting that they had received any training on ST. In those who received training, residency (59.3%) and on-the-job training (42.1%) were the most common sources with only 28.1% receiving training in medical school. Most participants (87.6%) agreed that formal training on addressing ST is important for OB/GYN clinicians and 74.4% were either very interested or interested in pursuing further training. Lecture and computer-based modules were the preferred modalities for further training. <h3>Conclusion</h3> Despite lack of prior training in addressing ST with patients, there was high interest in OB/GYNs for further training on ST and future efforts should focus on incorporating in-person and computer-based content into continuing education.

8120 Differences in OB/GYN Clinician Comfort and Barriers in Addressing Sexual Trauma

<h3>Study Objective</h3> To assess OB/GYN clinician comfort and barriers in addressing sexual trauma (ST). <h3>Design</h3> A 50-item electronic questionnaire. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> 129 practicing OB/GYN clinician members of the American Association of Gynecologic Laparoscopists or the International Pelvic Pain Society were surveyed. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Ninety-four percent of participants believed discussing ST is part of their role as clinicians, although only 69.8% reported routinely screening for ST and 71.3% indicated at least one barrier to discussing ST with patients. The most common barriers listed included lack of proper resources or available referrals (70.7%), lack of training in discussing ST (60.9%), limited time with patients (58.7%) and fear of re-traumatization (56.5%). Although female participants reported more barriers in discussing ST when compared to male participants (85.3% v 57.1%, p<0.0005), they were also more likely to screen patients for a history of ST (80.8% v 52%, p=0.001). Younger participants were more likely to report barriers in discussing ST when compared to older participants (p<0.05), and clinicians in training had a significantly higher interest in receiving further training on ST when compared to attending physicians (p<0.05). American OB/GYN clinicians were more likely to believe discussing ST to be a part of their role when compared to international clinicians (97.9% v 87.1%, p=0.03). Additionally, American clinicians were more likely to screen patients for a history of ST and had significantly higher scores on a Likert scale of 0-10 for both comfort and preparedness in addressing ST compared to international clinicians (p<0.05). <h3>Conclusion</h3> Despite barriers, in this study female and American clinicians were more likely to address, and comfortable with addressing, ST. Additionally, younger clinicians were more eager for further training opportunities. This study suggests a need for additional training on ST for OB/GYN clinicians.

Endometriosis classification systems: an international survey to map current knowledge and uptake.

STUDY QUESTIONWhich classification system for endometriosis do clinicians use most frequently, and why?SUMMARY ANSWEREven with a high uptake of the three existing endometriosis classification systems, most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis.WHAT IS KNOWN ALREADYIn the field of endometriosis, several classifications, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice.STUDY DESIGN, SIZE, DURATIONA survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains—participants background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020.PARTICIPANTS/MATERIALS, SETTING, METHODSA cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. The particular focus was on the three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the endometriosis fertility index (EFI), and the ENZIAN classification. Data were analysed to detect statistically significant differences among user groups.MAIN RESULTS AND THE ROLE OF CHANCEThe final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, while the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The vast majority of respondents replied positively to the question on whether they would use a simple surgical descriptive system available for endometriosis, if available.LIMITATIONS, REASONS FOR CAUTIONWhile the total number of respondents was acceptable, some regions/professions were not sufficiently represented to draw conclusions.WIDER IMPLICATIONS OF THE FINDINGSThe findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardized reporting and is clinically relevant and simple. The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system.STUDY FUNDING/COMPETING INTEREST(S)The meetings and activities of the working group were funded by the American Association of Gynecologic Laparoscopists, European Society for Gynecological Endoscopy, ESHRE and World Endometriosis Society. A.W.H. reports grant funding from the MRC, NIHR, CSO, Roche Diagnostics, Astra Zeneca, Ferring, Charles Wolfson Charitable Trust, Standard Life, and consultancy fees from Roche Diagnostics, AbbVie, Nordic Pharma and Ferring, outside the submitted work. In addition, A.W.H. has a patent Serum biomarker for endometriosis pending. He is Chair of TSC for STOP-OHSS and CERM trials and Chair of RCOG Academic Board 2018–2021. M.A. reports being member of the executive board and vice president of AAGL. N.P.J. reports personal fees from Abbott, Guerbet, Myovant Sciences, Vifor Pharma, Roche Diagnostics outside the submitted work; he is also President of the World Endometriosis Society and chair of the trust board. S.M. reports grants from AbbVie, DoD, NIH and Marriot Family Foundation, honoraria from University British Columbia and WERF, support for speaking at conferences (ESHRE, CanSAGE, Endometriosis UK, UEARS, IFFS, IASP, National Endometriosis Network UK) participation on Advisory Boards from AbbVie and Roche, outside the submitted work. She also discloses having a leadership or fiduciary role in SWHR, WERF, WES, ASRM and ESHRE. C.T. reports grants, consulting and speakers’ fees non-financial support and other from Merck SA, non-financial support and other consulting fees from Gedeon Richter and Nordic Pharma, and support for meeting attendance non-financial support from Ferring Pharmaceuticals, outside the submitted work and without private revenue. K.T.Z. reports grants from Bayer Healthcare, MDNA Life Sciences, Volition Rx, and Evotec (Lab282—Partnership programme with Oxford University), non-financial support from AbbVie Ltd, all outside the submitted work; and is a Board member (Secretary) of the World Endometriosis Society and World Endometriosis Research Foundation. J.P. reports personal fees from Hologic, Inc., outside the submitted work; he is also a member of the executive boards of ASRM and SRS. The other authors had nothing to disclose.

#Twitterimpact: The Impact of Oral Praesentation Tweets at Gynecologic Society Scientific Meetings on Journal Publication

<h3>Study Objective</h3> This study aims to examine the use of Twitter at leading gynecologic surgery society meetings and the impact of Twitter activity on ultimate journal acceptance. <h3>Design</h3> We examined oral presentations at the national conferences of the American Urogynecologic Society (AUGS), the Society of Gynecologic Surgeons (SGS), and the American Association of Gynecologic Laparoscopists (AAGL) from 2017-2019. We accessed the final program on each society's webpage to determine the oral presentations. We excluded video presentations. We then queried PubMed, Google, and GoogleScholar for the same oral presentation title and author names to determine whether the paper had been published. If the paper was published, the name of the journal and Altmetric scores were collected. Twitter profiles were determined based on a Google Search of the presenter or authors' names and the word "Twitter." We then queried Twitter using the collected profiles and hashtags pertaining to each conference (e.g., #SGS2019, #AUGSIUGA2019) to find related tweets. Presentation characteristics were analyzed using descriptive statistics. Comparisons were made using Kruskal-Wallis, Chi-square and Spearman Correlation tests. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Final review included 1,020 oral presentations (361 at AUGS, 131 at SGS, 528 at AAGL). Publication rate was compared between tweeted vs. non-tweeted oral presentations (Table 1). 144 articles with tweets had a statistically significant acceptance rate of 56.2% compared to 42.4% in 876 non-tweeted articles (p= 0.003). The Altmetric score showed a small but significant spearman correlation coefficient of 0.17 with number of tweets (p= <0.001). Tweeted presentations had an average Altmetric score of 6.3 (SD=17.3) compared to 3.7 (SD=17.8) in non-tweeted presentations (p value <0.001). <h3>Conclusion</h3> Tweeted oral presentations when compared to non-tweeted oral presentations at national gynecologic meetings are associated with higher rates of journal publication and Altmetric scores.