Impact of trainees involvement on surgical outcomes of abdominal and laparoscopic myomectomy.

BACKGROUND: To determine the association of trainees involvement with surgical outcomes of abdominal and laparoscopic myomectomy including operative time, rate of transfusion, and complications. METHODS: A retrospective cohort study of 1145 patients who underwent an abdominal or laparoscopic myomectomy from 2008-2012 using the American College of Surgeons National Surgical Quality Improvement Program database (Canadian Task Force Classification II-2). RESULTS: Overall, 64% of myomectomies involved trainees. Trainees involvement was associated with a longer operative time for abdominal myomectomies (mean difference 20.17 minutes, 95% Confidence Interval (CI) [11.37,28.97], p < 0.01) overall and when stratified by fibroid burden. For laparoscopic myomectomy, there was no difference in operative time between trainees vs no trainees involvement (mean difference 4.64 minutes, 95% CI [-18.07,27.35], p = 0.67). There was a higher rate of transfusion with trainees involvement for abdominal myomectomies (10% vs 2%, p < 0.01; Odds Ratio (OR) 5.62, 95% CI [2.53,12.51], p < 0.01). Trainees involvement was not found to be associated with rate of transfusion for laparoscopic myomectomy (4% vs 5%, p = 0.86; OR 0.82, 95% CI [0.16,4.14], p = 0.81). For abdominal myomectomy, there was a higher rate of overall complications (15% vs 5%, p < 0.01; OR 2.96, 95% CI [1.77,4.93], p < 0.01) and minor complications (14% vs 4%, p < 0.01; OR 3.71, 95% CI [2.09,6.57], p < 0.01) with no difference in major complications (3% vs 2%, p = 0.23). For laparoscopic myomectomy, there was no difference in overall (6% vs 10% p = 0.41; OR 0.59, 95% CI [0.18,2.01], p = 0.40), major (2% vs 0%, p = 0.38), or minor (5% vs 10%, p = 0.32; OR 0.52, 95% CI [0.15,1.79], p = 0.30) complications. CONCLUSION: Trainees involvement was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy, however, did not impact surgical outcomes for laparoscopic myomectomy.

TITLE: Trainees Involvement in MyomectomyThe goal of our study was to determine the association of trainees involvement with surgical outcomes of fibroid excision surgery or myomectomy. We conducted a study of abdominal and laparoscopic myomectomies using an international surgical database. We found that trainees involvement in myomectomy was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy. However, trainees involvement did not impact surgical outcomes for laparoscopic myomectomy.

Virtual postoperative visits following robotic gynecologic surgery: a study of patient satisfaction, safety, and feasibility.

Since the onset of the COVID-19 pandemic the use of telehealth has burgeoned. Numerous surgical specialties have already adopted the use of virtual postoperative visits, but there is data lacking in both robotics and gynecology. In this single-institution prospective cohort study we sought to evaluate the patient satisfaction, feasibility and safety of postoperative telehealth visits following robotic gynecologic surgery. Thirty-three patients undergoing robotic gynecologic procedures participated in a postoperative telehealth visit approximately 2 weeks following surgery, of which 27 completed a survey which assessed participant satisfaction with the telehealth visit, overall health-related quality of life following surgery, exposure to telehealth visits, and social determinants of health. The mean satisfaction score was just below 'excellent'. Only 2 participants (6.3%) required an in-person visit. Postoperative telehealth visit satisfaction score was significantly associated only with BMI (Pearson r = 0.45, p = 0.018). These data suggest that telehealth visits following robotic gynecologic procedures appear to be safe and feasible, and are associated with a high level of patient satisfaction.

Utility of Routine Preoperative Laboratory Testing for Low-risk Patients in Ambulatory Gynecologic Surgery.

STUDY OBJECTIVES: To examine the current use of routine preoperative laboratory testing in low-risk patients undergoing ambulatory gynecologic surgery and to determine if such testing affects surgical outcomes. DESIGN: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for ambulatory gynecologic surgeries between 2015 and 2018. Low-risk patients included in this study were defined as being American Society of Anesthesiologists class 1 or 2. The rate of preoperative laboratory testing before ambulatory gynecologic surgery in low-risk patients was determined and factors associated with testing including patient characteristics and comorbidities were evaluated. NSQIP-defined complications were compared between those with and without preoperative laboratory testing. Preoperative laboratory testing was defined as chemistry, hematology, coagulation, or liver function studies obtained within 30 days preoperatively. SETTING: National health systems that participate in the NSQIP. PATIENTS: There were 19 855 patients who underwent an ambulatory gynecologic procedure. INTERVENTIONS: Preoperative laboratory testing in low-risk patients before ambulatory gynecologic surgery. MEASUREMENTS AND MAIN RESULTS: Of the 19 855 patients studied, 14 258 (71.8%) received preoperative laboratory testing. Statistically significant differences were seen between patients who underwent preoperative testing and patients who did not. The most frequent preoperative test was a complete blood cell count (70.4%). Among patients who received preoperative testing, 4053 (28.4%) had at least 1 abnormal result. No statistically significant difference was seen in overall postoperative complication rate when comparing patients who received preoperative laboratory testing with those who did not (2.5% vs 2.2%, p = .30). Specifically, no statistically significant difference was seen among wound complications (1.0% vs 1.0%, p = .78), major complications (1.0% vs 0.8%, p = .11), unplanned return to the operating room (0.1% vs 0.2%, p = .40), unplanned readmission (0.7% vs 0.5%, p = .10), or overall morbidity (2.1% vs 1.9%, p = .38). Chi-square analyses were performed to compare categoric variables. Continuous variables were compared using unpaired t tests. CONCLUSION: This large study using a reputable national database revealed that despite updated evidence-based guidelines that recommend against the practice, preoperative laboratory testing continues to be performed for most low-risk patients undergoing ambulatory gynecologic surgery. This study also further supports current guidelines in demonstrating no difference in surgical outcomes between low-risk patients who did and did not receive preoperative laboratory testing. Preoperative laboratory testing practices for low-risk patients undergoing ambulatory gynecologic surgery do not follow current evidence-based guidelines and should be re-evaluated.

Absent Ureteral Efflux after Hysterectomy Leads to Diagnosis of Ureteral Atresia with Renal Atrophy.

Iatrogenic injury to the urinary system is a known complication of gynecologic surgery; therefore, intraoperative cystoscopy is frequently performed to assess for such injuries. However, if an abnormality is seen, the differential diagnosis extends beyond iatrogenic causes. A 42-year-old patient underwent a total abdominal hysterectomy and had absent efflux from the right ureteral orifice on cystoscopy. While iatrogenic injury was initially suspected, the intraoperative workup (including intravenous pyelography (IVP)) that ensued led to an empiric diagnosis of right ureteral atresia with ipsilateral renal atrophy that was then confirmed on postoperative imaging. When an abnormality is seen on cystoscopy following gynecologic surgery, it is important to maintain a broad differential diagnosis and to pursue an intraoperative workup with early involvement and close collaboration with urology.