APGO

Poster
Soorena Fatehchehr, MD University of Oklahoma Tulsa School of Community Medicine, Tulsa, Oklahoma

Elisa Ramunno, JD , Amber Bledsoe, MD , Michael O. Gardner, MD, MPH , Nora M. Doyle, MD, MPH, MSc

Objectives: Robotic surgery initially designed for battlefield surgery by the U.S. military, became FDA approved for gynecological surgery in 2005. Current uses of robotic surgery include: tubal reversal, myomectomy, hysterectomy, sacrocolpopexy, and oncology procedures. Robotic surgery represents an educational challenge. It is associated with a significant learning curve and a large amount of time and energy is necessary to develop and maintain skills. Currently, robotic training for inexperienced, practicing surgeons is primarily done at sponsored day or weekend courses, with limited proctorship opportunities. Ideally, fellowship training could provide a structured comprehensive program to acquire this skill set. To more fully understand the impact of robotic surgery on fellowship education, we developed a survey to evaluate the current state of robotic training in US fellowship programs.

Methods: A 45 point questionnaire was sent to all Gyn-Onc, REI, UroGyn, MIS fellows and Fellowship directors . OU IRB approval was obtained prior to study onset. We gathered information on demographics, including size of fellowship programs and procedures performed. Univariate and multivariate analysis were performed where appropriate. A p value of less than 0.05 was considered significant.

Results: 546 surveys were sent and 102 responses were collected. Of these, 2/3rd were Fellows and 1/3rd were Fellowship Directors. Our responses were equally distributed from all four fellowships surveyed. Over half of the fellowships reported that they were doing <10% of their surgeries vaginally. 70% responders stated 10 - 40 % of their surgeries done with robot. 80% of fellowship programs are performing at least 10% of their surgeries robotically. 95% reported that conversion to laparotomy occurred < 10% of the time. GYN ONC reports treating 34% of endometrial and 23% of cervical cancers via the robot. Minimal invasive fellowships noted 28% Hysterectomies, 31% Myomectomies, 15% Pelvic Organ Prolapse (POP), and 4% Paravaginal repair were done with the use of the robot. Uro/gyn fellowships stated 40% Sacrocolpopexy, 27% POP were done with the robot. REI fellowships reported robot use in 12% LOA and tubal reanastomosis, 14% hysterectomies, 15% myomectomies, and 5% endometriosis cases. Approx 70% programs report that there is robotic training in the fellowship curriculum. 25% of programs have > 25 hours dedicated specifically to robotic training. 80% report hands-on training, > 50% report that simulator training is available. Finally, 50% of programs report their graduating fellows have > 50 robotic cases at completion of their fellowship.

Conclusions: Robotic surgery has become an accepted modality nationally. Systematic approach for training all GYN fellows appears to offer solutions to how we learn the robot. Incorporation of resident education remains uncultivated.