Purpose: To create an interactive model allowing trainees to practice laparoscopic entry, gaining confidence with managing rare injuries.
Background: The milestones compiled by the ACOG and the ACGME set guidelines for residents performing endoscopy independently, recognizing and managing intraoperative complications. GI injuries occur at a rate of 0.05% to 0.65% in gynecologic procedures. They account for approximately 20% of all laparoscopic complications and roughly half occur at the time of entry. The rate of vascular injury ranges from 0.01% to 0.64% with mortality rates of 12-23%.
Methods: We performed a needs assessment of our laparoscopic curriculum
and identified that residents were uncertain of how to manage bowel, bladder,
minor and major vessel injury. An abdominal model was made using inexpensive
material including a large foil roasting pan, pool noodles, IV bags with food
coloring, a fountain pump, OR table padding foam, and elastic compression
stockings.
Instruction was provided before the simulation on basic laparoscopic technique
and risks. Trainees were divided into teams, given a brief synopsis and then
decided on method and location of entry. During abdominal entry they
encountered and managed one of the aforementioned injuries.
Residents completed pre/post questionnaires to assess their perceived knowledge
and comfort.
Results: A total of 17 residents participated in the study. Among
seniors (n=7), there was no significant change in overall comfort with a score
of 6.8/10 (SD 1.06) prior to the session and 7.1/10 (SD 1.16) after (p=0.68).
There was improvement in knowledge of bladder repair (50% to 80%) and major
vessel injury (50% to 100%).
Of the junior residents(n=10), there was a significant overall improvement in
comfort from 3.5/10 (SD 1.0) to 5/10 (SD 1.15) (p=0.02). All juniors
reported improved understanding for managing injuries to bowel (11% to
88%), bladder (22% to 66%), minor vessels (66% - 100%) and major vessels (0 to
100%). Of all levels, 100% of residents reported that the study was effective
in teaching management of rare laparoscopic injuries.
Discussions: ACOG recommends that our curriculum should include education in the instrumentation, technique, and evaluation of findings of laparoscopy. This affordable model is an effective form of reviewing injuries upon laparoscopic entry.
Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Residency Coordinator, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Simulation, Lecture, Minimally Invasive Surgery, General Ob-Gyn,
Arielle Gire-Dumas, MD, University of California Davis School of Medicine; Stacey Wallach, MD
