Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Southern California Permanente Medical Group, San Diego, CA.
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Southern California Permanente Medical Group, Downey, CA.
Perm J. 2021 May 26;25:20.224. doi: 10.7812/TPP/20.224.
We developed a novel fellow education pathway for robotic-assisted sacrocolpopexy (RASC) and aimed to compare step-specific and total operative times for RASC performed by Female Pelvic Medicine and Reconstructive Surgery (FPMRS) attendings with those in which FPMRS fellows performed part or all of the RASC. We further aimed to compare complication and readmission rates by fellow involvement.
We tracked RASC at 1 institution between 2012 and 2018. We recorded times for total procedure, sacrocolpopexy, and 6 individual steps. Fellows were designated F1-F3 by training year. We used independent samples t-tests and analysis of variance for continuous variables and χ and Fisher's exact tests for categorical variables.
Of 178 RASC procedures, 76 (42.7%) involved fellows. Concomitant procedures included hysterectomy (62.4%), midurethral sling (50%), and colporrhaphy/perineorrhaphy (51.7%). RASC without and with fellows had similar demographic, clinical, and procedural characteristics, except for midurethral sling rate (attending, 42.2% vs fellow, 60.5%; p = 0.02). RASC without and with fellows had similar times for total procedure (208.9 ± 61.0 vs 209.1 ± 48.6 minutes, p = 0.98), sacrocolpopexy (116.9 ± 39.9 vs 122.7 ± 29.2 minutes, p = 0.27), and all RASC steps except docking (attendings, 9.9 ± 8.6 vs fellows, 7.2 ± 7.0 minutes; p = 0.03). Complication rates and severity were similar without and with fellows. There were no readmissions.
DISCUSSION/CONCLUSION: Our novel structured training program provides safe limitations for total and step-specific procedural times during fellowship education in RASC. Such training programs warrant further study to determine potential contribution to quality and safety in the teaching environment.
我们为机器人辅助经阴道骶骨固定术（RASC）开发了一种新的培训途径，旨在比较女性盆底医学和重建外科医生（FPMRS）进行的 RASC 手术中，特定步骤和总手术时间与由 FPMRS 学员完成部分或全部 RASC 手术的时间。我们还旨在比较由学员参与引起的并发症和再入院率。
我们在 2012 年至 2018 年间在一家机构跟踪 RASC 手术。我们记录了总手术过程、骶骨固定术和 6 个单独步骤的时间。学员根据培训年限被指定为 F1-F3。我们使用独立样本 t 检验和方差分析比较连续变量，使用卡方和 Fisher 精确检验比较分类变量。
在 178 例 RASC 手术中，有 76 例（42.7%）涉及学员。同时进行的手术包括子宫切除术（62.4%）、中尿道吊带术（50%）和阴道修补术/会阴修补术（51.7%）。没有学员参与和有学员参与的 RASC 手术具有相似的人口统计学、临床和手术特征，除了中尿道吊带术率（医生，42.2%；学员，60.5%；p = 0.02）。没有学员参与和有学员参与的 RASC 手术的总手术时间（208.9 ± 61.0 分钟 vs. 209.1 ± 48.6 分钟，p = 0.98）、骶骨固定术时间（116.9 ± 39.9 分钟 vs. 122.7 ± 29.2 分钟，p = 0.27）和所有 RASC 手术步骤，除了对接（医生，9.9 ± 8.6 分钟 vs. 学员，7.2 ± 7.0 分钟；p = 0.03）。没有学员参与和有学员参与的手术并发症发生率和严重程度相似。没有再入院。
讨论/结论：我们新的结构化培训计划为机器人辅助经阴道骶骨固定术（RASC）培训中的总手术时间和特定步骤手术时间提供了安全限制。此类培训计划值得进一步研究，以确定在教学环境中对质量和安全的潜在贡献。
