An Initiative to Increase Resident Performance of Operative Vaginal Deliveries.

The objective of this single-centre, action research study was to increase resident experience performing operative vaginal deliveries. The secondary objective was to assess the incidence of maternal and neonatal complications. The rate of forceps deliveries increased in the post-training period (1.8%-4.0%; P < 0.001) but the overall rate of operative vaginal delivery did not change. The composite maternal complications rate following forceps delivery was lower in the post- training period (P = 0.006). There were no significant differences in maternal or neonatal complications with vacuum delivery between the periods before and after the initiative. Experiential training of residents may be a viable alternative to simulation training as it does not require expensive state-of-the-art simulation technology.

Robotic transabdominal cerclage: a case series illustrating costs.

The incidence of cervical insufficiency is 0.1-1% of all pregnancies and 8% of second trimester losses. After failed vaginal cerclages or in patients with amputated or congenitally abnormal cervices, transabdominal cerclages may be performed. Recent advances allow for use of the da Vinci robot to perform transabdominal cerclages. This case series presents three cases of robotically placed cerclages, performed prior to pregnancy. All patients had experienced prior second trimester losses. Two of the three had previously failed vaginal cerclage placement. All patients were discharged home the same day with minimal intraoperative blood loss and postoperative pain. Though, historically, robotic surgeries are more expensive, the total hospital costs for the three robotic cerclages were similar to the open abdominal approach performed at the same institution. These cases suggest robotically placed cerclage as a viable and less invasive alternative to the traditional transabdominal cerclages.