Perineoplasty Research Articles

Advantages of the modified colpocleisis operation in patients with atypical types of pelvic organ prolapse

Background: Currently, there is no general universal unified surgical treatment strategy for patients with pelvic organ prolapse. Considering the risks of installing mesh implants and the increasing incidence of implant-associated complications, mesh-free pelvic floor surgery techniques have become relevant again. A method was developed and introduced into clinical practice, which is an electrosurgical vaginal hysterectomy followed by vaginal suturing using a modified colpocleesis operation, which allows combining all the advantages of this method and at the same time minimizing the risks of cancer in the future. Aim: The aim of this study was to improve the results of surgical treatment in patients with rare, complicated and recurrent forms of pelvic organ prolapse. Materials and methods: This study included 140 patients diagnosed with pelvic organ prolapse. The main group consisted of 70 individuals with rare, severe and complicated cases of genital prolapse, who underwent surgical treatment using our modified colpocleisis operation. The control group comprised 70 other individuals with newly diagnosed uncomplicated cases of pelvic organ prolapse, who underwent surgical treatment using mesh implants. Results: All patients underwent planned surgical treatment. The operated patients were monitored for 1–5 years. In the main group, the effectiveness of the operation was 100%, while the effectiveness of surgical treatment with a mesh implant in the control group was 95.7%. All patients in the main group had complete tissue healing. There were no cases of long-term complications or relapses in any of the patients. Conclusions: the use of the modified colpocleisis operation for atypical types of pelvic organ prolapse is a highly effective method of prolapse correction. This, in combination with a simple execution technique, allows it for being offered as a basic method for vaginal access in patients without sexual activity.

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report.

Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF. A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o'clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula. Self-inflicted complex VVF. The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing. Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient's quality of life. The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

Effects of dural puncture epidural technique with different drug delivery methods for labor analgesia: A randomized controlled clinical trial.

This study aimed to investigate the effect of dural puncture epidural (DPE) combined with small-dose lidocaine for labor analgesia. Parturients were randomly divided into epidural anesthesia (EA), DPE1, and DPE2 groups. In the EA group, 5 mL of 1% lidocaine was administered via conventional L2-L3 puncture catheterization; in the DPE1 group, epidural drug was administered after catheterization using the DPE technique; in the DPE2 group, epidural puncture drug was administered through the epidural puncture needle before catheterization using the DPE technique. The primary outcome was the onset time of analgesia. The secondary outcomes included the numerical rating scale (NRS) scores during uterine contraction before bolus injection of experimental dose (T0) and the second time (T1), the fifth time (T2) and the tenth time (T3) after bolus injection of experimental dose; NRS scores at the second stage of labor (T4) and during perineal suture (T5); operation time of anesthesia; puncture related complications; anesthesia related complications; delivery outcome; use of local anesthesia during vaginal suture; and Apgar score of the neonates. There were 115 women included. The onset time in the DPE2 group was markedly shorter than in the EA and DPE1 groups (P < .001). The NRS scores in the DEP2 group at T1 and T4 were significantly lower than in the EA and DEP1 groups (P < .001). The overall incidence of puncture related complications in the DEP1 and DEP2 groups was markedly higher than in the EA group (P < .05). In dural puncture epidural analgesia, when the experimental dose was injected directly through the epidural puncture needle, the onset time was shorter and the analgesic effect was better as compared to the injection of test dose after inserting the epidural catheter.

Development and Validation of a Uterine Prolapse, Epidural, and Vaginal Suture Model.

Uterine prolapses sporadically present to bovine practitioners. Exposing veterinary students to this is challenging due to the inability to replicate a live animal prolapses in a teaching environment. The objective of this study was to develop a model that represents each step of the process of correcting a uterine prolapse and to perform a validation study of the model and rubric used to score performance using a skill comparison between experienced veterinarians and novices (students). The model was designed and built, and 27 students and 18 bovine veterinarians were recruited to participate in the evaluation of this model. Each participant performed each step of the model while being video recorded. Following model use, all participants completed a survey on their prior experiences and opinions of the model. Videos were viewed, and performances scored by one author using a rubric. Opinions on the model were mostly favorable in regard to use and realistic experience. There was no significant difference between the scores of veterinarians and veterinary students. However, there was an association with an excellent level of global rating scores for veterinarians while the veterinary student participants were associated with borderline satisfactory to good competency levels except for the epidural. There was a statistically significant association between the global rating scores and the check list competency levels. The lack of significant difference may be attributed to students previous experiences Based on feedback from the survey responses, the model will be used in clinical skills labs to provide experience in this area.

Midwifery in Abu Dhabi: A descriptive survey of midwives

BackgroundMidwives of international standards may save lives on a scale unmatched by any other intervention. There are limited trained midwives in Abu Dhabi. Midwifery may be eroded or diminished if there is attrition and/ or no succession of trained midwives (Bharj et al., 2016). Therefore, high quality midwifery education is needed. AimThis study aimed to describe midwifery in Abu Dhabi to inform the development of a new midwifery education degree program. MethodsIn 2022, midwives working in Abu Dhabi were invited to an anonymous online questionnaire. Data collected included characteristics such as age, qualification, duration of practice, practice setting, and skills used. Excel was used to perform descriptive statistics. FindingsSeventeen midwives participated (N = 17). The majority (58.8%, n = 10) work in Labour Ward, four midwives rotated to antenatal, labour, and postnatal areas (23.5%, n = 4). Midwives came from many countries, but there were no midwives of Emirati nationality. Seventy per cent held Undergraduate (70.5%, n = 12) and almost a third held Postgraduate (29.5%, n = 5) midwifery degrees. Skills commonly used included parentcraft (47.0%, n = 8), promoting physiologic labour and birth encouraging freedom of movement (93.8%, n = 15), facilitating safe spontaneous vaginal births (88.2%, n = 15), perineal and vaginal suturing (68.8%, n = 11) and immediate care of the newborn (100.0%, n = 17). Midwives less commonly led antenatal assessments (37.5%, n = 6) and worked in postnatal areas (31.3%, n = 4). ConclusionUnderstanding midwives' characteristics, where they work, and skills used may inform Midwifery education. Having more midwives will strengthen midwifery and increase women’s choice for respectful, safe maternity care.

Management of Vaginal Hyperplasia in Bitches by Bühner Suture.

Vaginal hyperplasia in bitch is an exaggerated response of the vaginal mucosa to estrogens during the proestral-estral phase of the cycle that can protrude through the vulvar lips. The present study refers to the management of vaginal hyperplasia in bitches by Bühner vulvar suture. Fourteen private-owners animals were refereed for spontaneous vaginal hyperplasia and complete protrusion of the mucosa, without ischemic or necrotic areas, which occurred during the proestral-estral phase. Under general anesthesia, prolapsed mass was cleaned with 50% glucose solution to reduce oedema and gently repositioned; the Bühner suture was applied using a Gerlach needle and a sterile vaginal suture tape, maintaining a minimal opening to allow urination in order to avoid possible recurrence in the same estrus. None of the bitches showed recurrence during the current cycle, proving the effectiveness of the Bühner suture. To prevent the possible recurrence of vaginal hyperplasia at the subsequent estrus, all the bitches underwent an ovariectomy 2 months later, when the Bühner suture was removed. In conclusion, the Bühner suture proved to be useful for the conservative treatment of vaginal hyperplasia in medium- or large-sized bitches. However, this approach should be considered only for cases in which the prolapsed mass does not show trauma, ulceration, ischemic or necrotic areas.

Association between the occurrence of adenomyosis and the clinical outcomes of vaginal repair of cesarean section scar defects: an observational study

BackgroundTo examine the correlation between the occurrence of adenomyosis and the outcome of vaginal repair of cesarean section scar defects (CSDs).MethodsA total of 278 women with CSD were enrolled in this retrospective observational cohort study at the Shanghai First Maternity & Infant Hospital between January 2013 and August 2017. Patients were divided into two groups according to preoperative magnetic resonance imaging (MRI) findings: the adenomyosis group and the non-adenomyosis group. They all underwent vaginal excision and suturing of CSDs and were required to undergo examinations 3 and 6 months after surgery. Preoperative and postoperative clinical information was collected. Optimal healing was defined as a duration of menstruation of no more than 7 days and a thickness of the residual myometrium (TRM) of no less than 5.8 mm after vaginal repair.ResultsBefore vaginal repair, for patients in the adenomyosis group, the mean duration of menstruation was longer and TRM was significantly thinner than those in patients in the non-adenomyosis group (p < 0.05). The TRM and duration of menstruation 3 and 6 months after surgery were significantly improved in both groups (p < 0.05). There were more patients with optimal healing in the non-adenomyosis group than in the adenomyosis group (44.7% vs. 30.0%; p < 0.05). Furthermore, 59.3% (32/54) of the women tried to conceive after vaginal repair. The pregnancy rates of women with and without adenomyosis were 66.7% (8/12) and 61.9% (26/42), respectively. The duration of menstruation decreased significantly from 13.4 ± 3.3 days before vaginal repair to 7.6 ± 2.3 days after vaginal repair in 25 patients (p < 0.001). The TRM increased significantly from 2.3 ± 0.8 mm before vaginal repair to 7.6 ± 2.9 mm after vaginal repair (p < 0.001).ConclusionsVaginal repair reduced postmenstrual spotting and may have improved fertility in patients with CSDs. Patients with adenomyosis are more likely to have suboptimal menstruation and suboptimal healing of CSDs. Adenomyosis might be an adverse factor in the repair of uterine incisions.

Prospective Evaluation of Laparoscopic Sacrocolpopexy with Concomitant Laparoscopic-Assisted Total Vaginal Hysterectomy

(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.

Vaginal Cuff Closure by Endosuturing in Total Laparoscopic Hysterectomy as Compared to Transvaginal Route of Suturing

Introduction: In present times, Total Laparoscopic Hysterectomy (TLH) is one of the commonly performed gynaecological procedure. Vaginal vault or cuff closure is crucial and critical in performance of TLH. During TLH, vaginal vault or cuff closure is done using a variety of available sutures. The techniques of suturing and approaches, either endoscopic or transvaginal, can vary. The skill, experience and preference of the surgeon counts in the final outcome of the surgery. Aim: To compare and study the frequency of minor and major complication rates of intracorporeal (endosuturing) cuff closure technique and routinely used transvaginal route of suturing vaginal vault in TLH. Materials and Methods: This prospective cohort research was conducted in the tertiary care hospital from May 2018 to December 2019. A total of 102 TLH were studied. In 51 cases (50%), vault was sutured endoscopically and in other 51 cases (50%), vault was sutured transvaginal, using single continuous interlocking suturing of vaginal vault with Vicryl 1-0 in all cases. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 24.0. Results: In the follow-up of three months period, there were no cases of Vaginal Cuff Dehiscence (VCD). In present study, 21 cases (20.6%) out of 102 presented with vaginal cuff complications. A 15.7% cases with minor vaginal cuff complications were noted in laparoscopic endosuturing group and 25.5% cases of vaginal suturing group presented with minor vaginal cuff complications. Conclusion: Both the techniques of suturing the vaginal vault following laparoscopic hysterectomy delivered the desired results. The laparoscopic route of suturing vaginal cuff following TLH had lesser complication rate though not statistically significant over vaginal route and none of the two groups had any major complication (VCD).

Ovarian transposition.

Vaginal evisceration of the small bowel is a surgical emergency insofar as it entails the risk of acute vascular lesions in the latter. It may be caused by a vaginal prolapse. Delayed treatment of a prolapse may entail the risk of poor scarring of vaginal suture, and sacrocolpopexy is not necessarily called for. In an 80-year-old female patient with repeatedly recurrent stage 4 vaginal prolapse, vaginal evisceration and vaginal prolapse were treated by perineal approach and emergency colpocleisis.

Epidemiology of Chlamydia psittaci infections in pregnant Thoroughbred mares and foals

Late-term foal loss due to the traditional avian pathogen Chlamydia psittaci recently emerged as a threat to the Australian Thoroughbred industry. A longitudinal study of 14 stud farms was undertaken to better understand C. psittaci infection in pregnant mares and their foals by evaluating C. psittaci prevalence, equine herpesvirus-1 (EHV-1) co-infection, avian reservoirs, and potential risk factors. Mucosal swabs taken from 228 healthy pregnant mares and their foals were tested for C. psittaci and EHV-1 using species-specific qPCR assays.No foal loss was recorded due to either pathogen, and no mare tested positive to either C. psittaci or EHV-1. However, healthy newborn foals tested positive to both pathogens, at low levels, with 13.2% (n = 30/228) and 14.5% (n = 33/228) prevalence for C. psittaci and EHV-1, respectively. Co-infection occurred in 1.3% (n = 3/228) of foals. In avian environmental faecal samples collected from the same studs, C. psittaci was detected at 5.3% (n = 5/94). Multiple logistic regression modelling found that foals born in winter were more likely to be infected with C. psittaci (adjusted odds ratio = 15.83; P < 0.001; Confidence Interval 5.12–48.49). Being a maiden mare, absence of prophylactic vaginal suture, interventions in the last trimester and residing on a farm with prior history of C. psittaci abortion posed no higher risk to infection in the newborn. Analysis of all reported C. psittaci abortion cases (Hunter Valley, 2016–2019) revealed a dominant C. psittaci sequence type (denoted ST24) and a significant correlation with frost events (Spearmans’ rho = 0.44; P = 0.002).

A Novel Transvaginal Cervical Cerclage Model for Resident Training.

IntroductionVaginal suturing can be challenging to teach and learn due to the surgical assistant's limited operative field visualization. Data on resident training and comfort with cerclage placement using models are limited. The aim of this activity was to assess learner satisfaction with practice using a novel model allowing for full visualization during transvaginal cervical cerclage placement.MethodsOB/GYN residents participated in a 1-hour combined lecture and hands-on cerclage training simulation with the novel model. Pre- and postsession survey responses were assessed with descriptive statistics and paired t tests.ResultsTwenty residents with a median of 2 (SD = 1.6) years of residency experience participated. Ninety-five percent reported no prior cerclage simulation training; 60% reported placing cerclages in practice. Pre- and posttest analysis indicated a significant decrease in perceived need for further training (M = 4.05, SD = 1.07, vs. M = 3.45, SD = 0.86; p = .024) and an increase in comfort performing a cerclage placement (M = 2.55, SD = 1.16, vs. M = 3.85, SD = 0.79; p < .001). After the simulation, residents reported more comfort in cerclage placement with decreasing supervision (M = 2.05, SD = 1.02, vs. M = 2.30, SD = 1.01; p = .021); 90% reported that learning to place a cerclage was easy.DiscussionImplementing a novel, low-cost model allowing full operative field visualization significantly improved reported comfort regarding cervical cerclage placement and resulted in high satisfaction amongst residents. Future research should evaluate the training's impact on clinical skills.

Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women

To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse. Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction. Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ). Individual procedures or broad categories of procedures were compared: (1) vaginal versus abdominal routes for reconstruction, (2) abdominal procedures for reconstruction, (3) vaginal procedures for reconstruction, (4) hysterectomy and suspension versus hysteropexy for reconstruction, and (5) reconstructive versus obliterative options. The Urogynaecology Committee selected outcomes of interest: objective failure (obtained via validated pelvic organ prolapse [POP] quantification systems and defined as overall objective failure as well as failure rate by compartment); subjective failure (recurrence of bulge symptoms determined subjectively, with or without use of a validated questionnaire); reoperation for POP recurrence; complications of postoperative lower urinary tract symptoms (de novo or postoperative stress urinary incontinence; reoperation for persistent, recurrent, or de novo stress urinary incontinence; urge urinary incontinence; and voiding dysfunction); perioperatively recognized urinary tract injury (bladder or ureter); other complications (mesh exposure, defined as mesh being visible and exposed in the vagina, and non-sexual pelvic pain); and sexual function (de novo dyspareunia and sexual function score according to a validated questionnaire). This guideline will benefit patients seeking surgical correction of apical POP by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from 2002 to 2019. The search included multiple terms for apical POP surgical procedures, approaches, and complications. We excluded POP repairs using transvaginal mesh and studies that compared procedures without apical suspension. We included randomized controlled trials and prospective or retrospective comparative studies. We limited language of publication to English and French and accessibility to full text. A systematic review and meta-analysis was performed. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). Gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and care for women with POP. All statements refer to correction of apical vaginal prolapse in the short and medium term (up to 5 years), except when otherwise specified.

Emergency colpocleisis in a vaginal prolapse complicated by bowel evisceration

Vaginal evisceration of the small bowel is a surgical emergency insofar as it entails the risk of acute vascular lesions in the latter. It may be caused by a vaginal prolapse. Delayed treatment of a prolapse may entail the risk of poor scarring of vaginal suture, and sacrocolpopexy is not necessarily called for. In an 80-year-old female patient with repeatedly recurrent stage 4 vaginal prolapse, vaginal evisceration and vaginal prolapse were treated by perineal approach and emergency colpocleisis.

Clinical outcomes after laparoscopic sacrocolpopexy for pelvic organ prolapse: A 3-year follow-up study.

To evaluate the mid-range subjective and objective success rate of laparoscopic sacrocolpopexy. Of the 317 women with pelvic organ prolapse who underwent laparoscopic sacrocolpopexy surgery at the same center between January 2013 and March 2015, we assessed 233 patients who were followed up for >3years. We carried out urogynecological examinations and used questionnaires for the postoperative assessment of the patients. Scoring 0points on question3 of the Pelvic Floor Distress Inventory-20 was considered to show subjective success. Objective success was defined as stage0 or 1 on the Pelvic Organ Prolapse Quantification. The subjective and objective success rates in the third year after surgery were 89.7% (209/233) and 90.6% (211/233), respectively, and those in the first year were 90.6% (211/233) and 91.0% (212/233), respectively. Perioperative complications included bladder injury (0.4%) in one case and vaginal wall injury (0.4%) in one case. Postoperative complications included the incidence of chronic pain (mesh retraction) in one case, which was the only case requiring re-operation due to complications (0.4%); vaginal suture exposure (0.4%) in one case; port-site hernia (0.4%) in one case; and subileus (0.4%) in one case. The complications associated with voiding function included de novo stress urinary incontinence (20.6%) in 48 cases, out of which there were 12 cases of de novo overactive bladder (5.2%) and eight cases required midurethral sling procedures. Laparoscopic sacrocolpopexy provides a good outcome with a low rate of subjective and objective recurrence and surgical complications.

Occult vaginal cancer recurrence after hysterectomy: a case report and literature review

Vaginal cancer is a rare disease of the lower genital tract. We present the case of a 54-year-old woman with occult vaginal cancer after hysterectomy for cervical intraepithelial neoplasia (CIN) III. Despite persistently negative cytology and colposcopy results, a lesion was finally detected by vagino-recto-abdominal examination and she underwent radical parametrectomy and lymph node dissection. We consider the possibility that transabdominal suturing of the vaginal cuff after hysterectomy may reduce the ability to detect subsequent vaginal lesions, and discuss the benefits of a vaginal suture approach. We recommend that suturing the vagina apex transvaginally instead of transabdominally would benefit patients during follow-up.

Recurrent cervical hemorrhages and thromboses associated to pulmonary thrombembolism in a hereditary thrombophilia with heterozygous mutants of MTHFR and PAI-1. Case Report and Pathophysiology Hypotheses

A 30 years Caucazian nullipara, 1 blighted ovum, former Yasmin user (1 year), without antiphospholipid antibodies, prophylactic cervical cerclage at 19 weeks pregnancy, is readmitted in emergency at 21 weeks gestation for heavy pelvic pains, and abundant vaginal red blood loss, with cerclage suppression. Under tocolysis and vaginal progesterone, she presents 3 new episodes of intense pains and red, pulsatile blood loss from different cervical areas at 24- 36 hours after admittance, with mechanical hemostasis by nylon sutures at cervico- vaginal junction. The 4th episode is followed by severe anemia (Hb= 6.03mg/dL, Ht= 18.32%), haemodinamic instability, coagulation disorders- hematomas, generalized petaechia, and at 24 hours after last vaginal sutures she claims thoracic pains, dyspneea, cianosis. There are not registered fetal distress, placental abnormalities, cervical shortness below 2.5 cm (when cerclage), and maternal heart abnormalities at repeated ultrasound examinations. No thoracic computer tomography because maternal refuse. After a cardiologist consultation it is appreciated a mild/moderate pulmonary thrombembolism, without deep legs venous thrombosis, and it is started continuous intravenous anticoagulant therapy – heparine 25,000UI/day x 6 days, then fraxiparine in increased dosages continued to term, and 6 weeks postpartum. The laboratory test confirms intravascular disseminated coagulation with secondary fibrinolysis, and positivity for heterozygous mutants of MTHFR (methylene tetrahydrofolate reductase deficiency C677T and A1298C), and PAI (plasminogen activator inhibitor)-1 (4G). Cesarean delivery is performed at 37 weeks for fetal distress at labor onset, with extraction of a girl 3340g, Apgar=7/8, premature senescent placenta, thin umbilical cord. No maternal and neonate postpartum complications.

Comparing Participant-Reported Confidence during Laparoscopic Vaginal Cuff Suturing after Training with Two Laparoscopic Simulators

Study Objective To determine if participants’ self-reported confidence level with performing a laparoscopic gynecologic surgical task was higher after training with a gynecology-specific laparoscopic trainer. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology (EMIG) or Fundamentals of Laparoscopic Surgery (FLS) – then underwent training on relevant simulation tasks for 2.5 hours (including peg transfer and intracorporeal knot tying). Measurements and Main Results Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were masked then graded using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool by high-volume minimally invasive gynecologic surgeons. Participants were not aware of their GOALS scores. All participants completed a survey at the conclusion of the session, rating their confidence level during each laparoscopic simulation task on a 5-point Likert scale. Confidence scores were compared using two sample t-tests with unequal variances. No statistically significant differences in confidence levels were noted between EMIG and FLS participants: peg transfer (diff=0.03, p=0.88), intracorporeal knot tying (diff=0.15, p=0.55) and vaginal cuff suturing (diff=0.41, p=0.11). Conclusion Neither EMIG participants nor FLS participants had higher self-rated confidence scores for the simulator tasks or the vaginal cuff suturing task with regard to statistical significance. However, when examining the raw data, confidence scores for all three tasks were higher for EMIG participants than FLS participants. These results suggest that EMIG-randomized participants may have felt better prepared to complete a laparoscopic gynecologic surgical task; however, larger studies are needed to demonstrate this conclusively.

Comparing Proficiency of Laparoscopic Vaginal Cuff Suturing in Naïve Learners after Training with Two Different Laparoscopic Simulators

Study Objective To determine if a gynecology-specific laparoscopic simulation trainer better prepares learners to perform a gynecologic surgical task than the current standard laparoscopic simulation trainer. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology (EMIG) or Fundamentals of Laparoscopic Surgery (FLS) – then underwent training on relevant simulation tasks for 2.5 hours. Measurements and Main Results Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were then masked to simulator group and test phase (pre-/post-test). High-volume minimally invasive gynecologic surgeons graded the videos using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool. Composite GOALS scores were compared using two sample t-tests with unequal variances. The mean difference between post- and pre-composite GOALS scores was 6.50 for EMIG and 4.07 for FLS, p=0.34. Differences in individual GOALS domains were compared using Wilcoxon Rank-Sum tests. The mean EMIG post-pre difference was greater for six of eight individual GOALS domains, though all p-values > 0.05. A post-hoc power analysis revealed n=127 per simulation group was needed to obtain p-value=0.05. Conclusion Neither EMIG nor FLS was associated with better performance on the vaginal cuff suturing task with regard to statistical significance. However, when examining the raw data, EMIG-randomized participants had a larger mean difference between post- and pre-test GOALS scores across multiple domains. These results suggest that EMIG may better prepare surgically naive learners to complete a laparoscopic vaginal cuff suturing task; however, larger studies are needed to demonstrate this conclusively.

Fine Motor Skills Task Experience and Laparoscopic Vaginal Cuff Suturing Performance after Training with Two Laparoscopic Simulators

Study Objective To determine if prior video gaming or fine motor skills task experience was associated with improved performance on a vaginal cuff suturing task following training with two laparoscopic simulators. Design Randomized controlled trial incorporating block randomization and a masked design. Setting Participants were trained and tested during a four-hour session in the Northwestern Center for Advanced Surgical Education simulation lab. Patients or Participants 45 surgically naive premedical and preclinical medical students were recruited from June-November 2019. Interventions Participants were randomized into two laparoscopic simulator groups – Essentials in Minimally Invasive Gynecology or Fundamentals of Laparoscopic Surgery – then underwent training on relevant simulation tasks for 2.5 hours. Measurements and Main Results Demographic information was collected for all participants, including fine motor skills task and video gaming experience. Participants completed a video-recorded pre-test and post-test on a laparoscopic vaginal cuff suturing model. Videos were masked then graded using a modified version of the Global Operative Assessment of Laparoscopic Skills (GOALS) tool by high-volume minimally invasive gynecologic surgeons. Two sample t-tests with unequal variances were employed to compare GOALS scores. Significant differences were noted in baseline pre-test composite GOALS scores for participants with prior experience playing instruments (diff=2.7, p=0.007), sewing (diff=2.3, p=0.03) and completing artistic tasks (diff=3.05, p=0.01). However, the mean difference between post- and pre-test composite GOALS scores was not different for participants with prior video gaming or fine motor skills task experience. Conclusion Participants with prior fine motor skills task experience performed better at baseline on the pre-test vaginal cuff model. However, after training, these same participants did not perform better when compared to those without prior fine motor task skill experience, regardless of simulation group. These results suggest that prior fine motor skills task experience may not predispose surgically naive learners to improved performance with certain laparoscopic simulation tasks.