The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center

ABSTRACT Purpose: To compare laparoscopic gynecological surgery training between a developed country’s reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center’s TI. Methods: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. Results: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. Conclusions: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient’s center with comparable surgical outcomes

Laparoscopic implantation of neural electrodes on pelvic nerves: an experimental study on the obturator nerve in a chronic minipig model

International audienc

Laparoscopic Promontofixation in 10 Steps

International audienc

Laparoscopic Ureteroneocystostomy with Vesicopsoas Hitch in 10 Steps - for Infiltrative Endometriosis of the Distal Ureter

International audienc

Performance Assessment for Total Laparoscopic Hysterectomy in the Operating Room: Validity Evidence of a Procedure-specific Rating Scale

International audienceStudy Objective: The technical conduct of total laparoscopic hysterectomy (LH) is critical to surgical outcomes. This studyexplored the validity evidence of an objective scale specific to the assessment of technical skills (H-OSATS) for 7 tasks ofan LH with salpingo-oophorectomy procedure performed in the operating room.Design: Observational cohort study.Setting: Two academic hospitals in Marseille and Montpellier, France.Patients: Three groups of operators (novice, intermediate, and experienced surgeons) were video recorded during their liveperformances of LH on a simple case. For each group, a dozen unedited videos were obtained for the following tasks: divisionof the round ligament, division of the infundibulopelvic ligament, creation of the bladder flap, opening of the posteriorperitoneum, division of the uterine vessels, colpotomy, and closure of the vault.Interventions: Two qualified raters blindly assessed each video using the H-OSATS rating scale. Inter-rater reliability andtest−retest reliability were calculated as measures of internal structure. In a separate round of evaluations, the raters provideda global competent/noncompetent decision for each performance. As a measure of consequential validity, a pass/failscore was set for each task using the contrasting group method.Measurements and Main Results: Three tasks (creation of the bladder flap, colpotomy, and closure of the vault) displayedsound validity evidence: a meaningful total score difference among the 3 groups of experience as well as between the intermediateand experienced surgeons, reliability outcomes of >0.7, and a pass/fail score with a theoretical false-positive rateof <10%.Conclusion: The validity evidence of the H-OSATS rating scale differed for separate evaluations of the 7 tasks. Three tasks(i.e., creation of the bladder flap, colpotomy, and closure of the vault) revealed sound validity evidence, including at thelevel of the attending surgeon, whereas other tasks were more consistent with low-stakes formative evaluation standards

Does experience in hysteroscopy improve accuracy and inter-observer agreement in the management of abnormal uterine bleeding?

Hysteroscopic reliability may be influenced by the experience of the operator and by a lack of morphological diagnostic criteria for endometrial malignant pathologies. The aim of this study was to evaluate the diagnostic accuracy and the inter-observer agreement (IOA) in the management of abnormal uterine bleeding (AUB) among different experienced gynecologists.Each gynecologist, without any other clinical information, was asked to evaluate the anonymous video recordings of 51 consecutive patients who underwent hysteroscopy and endometrial resection for AUB. Experts (&gt; 500 hysteroscopies), seniors (20-499 procedures) and junior (aecurrency sign19 procedures) gynecologists were asked to judge endometrial macroscopic appearance (benign, suspicious or frankly malignant). They also had to propose the histological diagnosis (atrophic or proliferative endometrium; simple, glandulocystic or atypical endometrial hyperplasia and endometrial carcinoma). Observers were free to indicate whether the quality of recordings were not good enough for adequate assessment. IOA (k coefficient), sensitivity, specificity, predictive value and the likelihood ratio were calculated.Five expert, five senior and six junior gynecologists were involved in the study. Considering endometrial cancer and endometrial atypical hyperplasia, sensitivity and specificity were respectively 55.5 % and 84.5 % for juniors, 66.6 % and 81.2 % for seniors and 86.6 % and 87.3 % for experts. Concerning endometrial macroscopic appearance, IOA was poor for juniors (k = 0.10) and fair for seniors and experts (k = 0.23 and 0.22, respectively). IOA was poor for juniors and experts (k = 0.18 and 0.20, respectively) and fair for seniors (k = 0.30) in predicting the histological diagnosis.Sensitivity improves with the observer's experience, but inter-observer agreement and reproducibility of hysteroscopy for endometrial malignancies are not satisfying no matter the level of expertise. Therefore, an accurate and complete endometrial sampling is still needed

Técnica laparoscópica reversa en el manejo quirúrgico de la endometriosis profunda del tabique rectovaginal: experiencia preliminar

Antecedentes: El tratamiento quirúrgico de la endometriosis profunda es un procedimiento complejo, asociado a un alto riesgo de complicaciones. Recientemente, el uso de la técnica laparoscópica reversa aparece como una variante técnica interesante con el fin de disminuir las complicaciones. Objetivo: Describir nuestra experiencia preliminar y demostrar la factibilidad de la técnica laparoscópica reversa en el tratamiento de la endometriosis profunda del tabique rectovaginal. Método: Reporte de 5 casos a partir de base de datos prospectiva. Resultados: La edad promedio de las pacientes fue 34,2 años (rango: 32-37 años). Todas las pacientes presentaban dismenorrea y dispareunia profunda de larga evolución y en 3 de ellas existía el antecedente de cirugías previas por endometriosis. El tiempo quirúrgico promedio fue 313 minutos (rango: 180-450 minutos). Todas las cirugías se completaron por laparoscopía y no se registraron complicaciones. La anatomía patológica confirmó endometriosis en todos los casos. El seguimiento promedio fue de 4 meses (rango: 2-8 meses). Conclusión: La técnica laparoscópica reversa es una alternativa factible en el manejo quirúrgico de la endometriosis profunda, sin embargo es una técnica compleja y debe ser realizada por equipos experimentados en cirugía laparoscópica

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