Current trends in minilaparoscopy.

PURPOSE OF REVIEW: The purpose of this review is to understand the current use of minilaparoscopy in the field and how minilaparoscopy compares with traditional laparoscopy in terms of operative times, complications, pain, and cosmesis. RECENT FINDINGS: Although there are few randomized controlled trials comparing minilaparoscopy with traditional laparoscopy in gynecologic procedures, the results suggest that minilaparoscopy can be performed safely with improved cosmetic outcomes and similar complication rates and operating times. Postoperative pain may be decreased with minimizing incisions sizes. Recently, case reports and case series have been published demonstrating the use of minilaparoscopy across many subtypes of gynecologic surgery. SUMMARY: Traditional laparoscopic surgery has become common practice in gynecology as it has been found to be a well tolerated procedure with improved outcomes and decreased morbidity when compared with laparotomy. Although minilaparoscopy has been used for over 2 decades, its role in gynecology is continuing to evolve. Minilaparoscopy is a growing surgical option in gynecology as we try to minimize the impact of surgery. Results of minilaparoscopy in gynecology mirror those found in urology and general surgery. Although research is limited, minilaparoscopy has proven to be a well tolerated alternative for gynecology.

Development of an affordable, immersive model for robotic vaginal cuff closure: a randomized trial.

Safe and secure closure of the vaginal cuff is a critical component of a robotic assisted hysterectomy procedure. Our aim in this study is to develop and validate a novel vaginal cuff closure model (VC) created from porcine heart that allows trainees to obtain competency in a low-risk environment. Ten expert and 20 novice robotic surgeons performed a cuff closure exercise on the VC model and on the dV-Trainer®, a virtual reality simulator (VR). Performances were timed, videotaped, and scored using the modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Expert robotic surgeons completed the task faster on both the VR (531 vs. 814 s, p = 0.03) and the VC platforms (311 vs. 631 s, p < 0.001) and achieved higher mGEAR scores (32.25 vs. 22.07, p < 0.0001). Knot quality and suturing accuracy were better in the VC than in the VR environment in both groups. In a post-completion survey, both expert and novice surgeons expressed strong preference towards the VC model. In this study, the novel VC model proved to be a reliable simulation tool with high face, content, and construct validity. Due to its simplicity and low cost, this high-yield simulation exercise can easily be incorporated into robotic training curricula of obstetrics and gynecology residents.