Development and validation of a simulation model for laparoscopic myomectomy

Schneyer, Rebecca J.; Molina, Andrea L.; Green, Isabel C.; Scheib, Stacey A.; Mara, Kristin C.; Siedhoff, Matthew T.; Wright, Kelly; Truong, Mireille

doi:10.1016/j.ajog.2022.04.042

Cited by 4 publications

(8 citation statements)

References 24 publications

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“…Numerous studies have shown that laparoscopic myomectomy is a minimally invasive and effective treatment for uterine fibroids. Laparoscopic myomectomy results in less blood loss, shorter hospitalisations and faster recovery times than does traditional open surgery 27 28. However, because of the limited speed of instrument operation and the fact that the uterine blood supply itself is relatively rich, bleeding has always been one of the major complications of hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic myomectomy results in less blood loss, shorter hospitalisations and faster recovery times than does traditional open surgery. 27 28 However, because of the limited speed of instrument operation and the fact that the uterine blood supply itself is relatively rich, bleeding has always been one of the major complications of hysterectomy. Other minimally invasive techniques, such as hysteroscopic myomectomy or uterine artery embolisation, have also been widely used and discussed.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

Shi,

Wu,

Liu

et al. 2024

BMJ Open

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ObjectiveThis study aimed to introduce a novel laparoscopic haemostasis for myomectomy and investigate the independent risk factors for uterine fibroid recurrence.DesignA retrospective cohort study.SettingFollowing strengthening the reporting of observational studies in epidemiology (STROBE) criteria, a retrospective study of prospectively collected available data of the consecutive patients who underwent the myomectomy in the department of obstetrics and gynaecology of the single centre between February 2018 and December 2020.Participants177 patients who underwent laparoscopic myomectomy resection were enrolled in the present cohort study.Materials and methodsPatients were classified into two groups according to their different methods of haemostasis in laparoscopic surgery. Recurrence-free survival was compared between the groups during an average follow-up of nearly 2 years.ResultsOf the 177 patients from 672 consecutive patients in the retrospective cohort, laparoscopic circular suture and baseball suture were carried out in 102 (57.6%) and 75 (42.4%) patients, respectively. The total amount of blood lost during surgery varied significantly (37.6 vs 99.5 mL) (p<0.001). Univariable analyses identified that age ≥40 years, position at intramural myoma, multiple fibroids and largest fibroid volume ≥50 mm3(HR 2.222, 95% CI 1.376 to 3.977, p=0.039; HR 3.625, 95% CI 1.526 to 6.985, p=0.003; HR 3.139, 95% CI 1.651 to 5.968, p<0.001; HR 2.328, 95% CI 0.869 to 3.244, p=0.040, respectively) are independent risk factor of the recurrence of uterine fibroids. The formula of the nomogram prediction model was established as the practical clinical tool.ConclusionThe laparoscopic continuous seromuscular circumsuture for myomectomy can effectively reduce the amount of surgical bleeding and accelerate the perioperative recovery for surgical safety. The main factors affecting the recurrence of uterine fibroids were age, location, number and volume of uterine fibroids. The nomogram can more straightforwardly assist clinicians to determine the risk of recurrence after laparoscopic myomectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

Shi,

Wu,

Liu

et al. 2024

BMJ Open

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“…Strengths of this model included its low cost of $4.40, reusable nature for minimal additional cost, and its ability to be modified to represent different sizes and locations of fibroids. Materials could all be easily obtained by the general population, for example, felt, plastic wrap, hook-and-loop fastener, and a stress ball [10,11]. Although the validity metrics of these three studies varied, common themes arose amongst participant experiences.…”

Section: Key Pointsmentioning

confidence: 99%

“…Although the validity metrics of these three studies varied, common themes arose amongst participant experiences. The vast majority of the users (66% to over 90%) felt the simulations were realistic, helpful, satisfying, effective, and improved preparedness for and confidence in the procedure [8][9][10][11].…”

Section: Key Pointsmentioning

confidence: 99%

Advances in gynecologic simulation: implementation, validity, and new resources

Edmonds,

Warner,

Endicott

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Simulation plays an integral role in gynecological surgical training that will continue and grow in the future. It aims to supplement surgical training as residents are experiencing decreased surgical volumes. It has also been recognized as a means for assessing a trainee's capabilities to the point of being incorporated into the board certification process. This review will highlight the recent updates in research and resources available for gynecologic surgery simulation. Recent findings The literature reviewed demonstrated that, across the board, participants in simulation find it beneficial. A variety of low-fidelity and high-fidelity models, virtual reality programs, and artificial intelligence technology have been developed recently. As the field advances, researchers have started to investigate methods to increased engagement and provide feedback without the need for direct observation, the logical next step considerations to maximize the impact and availability of simulation. Summary Gynecologic surgery training programs must stay abreast of the wide variety of simulation training available. Efforts should continue to be made to investigate the impact of simulation patient outcomes. The academic medicine community has a responsibility to ensure high-quality simulation is available to all surgical trainees to avoid disparities between low-resource and high-resource programs.

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“…The most common reported form was inter-rater reliability with 10 out of 13 (76.9%) global rating tools and 10 out of 13 (76.9%) procedurespecific tools. All manual global tools report good to excellent inter-rater reliability, [23][24][25]30,33,35,[37][38][39][40]57,[61][62][63][64][65][66][67][68][69][70] with the exception of one modified OSATS in a dry laboratory setting for a simple laparoscopic ovarian cystectomy by Chahine et al 71 Inter-rater reliability among procedure-specific tools [31][32][33][42][43][44]46,47,59,60 showed good to excellent correlation except for specific domains for the H-OSATS and the dissection assessment for robotic technique. 43,60 Intrarater reliability was reported for 4/13 (30.8%) global tools demonstrating excellent intrarater reliability.…”

Section: Internal Structurementioning

confidence: 99%

Objective assessment tools in laparoscopic or robotic‐assisted gynecological surgery: A systematic review

Tesfai,

Nagi,

Morrison

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionThere is a growing emphasis on proficiency‐based progression within surgical training. To enable this, clearly defined metrics for those newly acquired surgical skills are needed. These can be formulated in objective assessment tools. The aim of the present study was to systematically review the literature reporting on available tools for objective assessment of minimally invasive gynecological surgery (simulated) performance and evaluate their reliability and validity.Material and methodsA systematic search (1989–2022) was conducted in MEDLINE, Embase, PubMed, Web of Science in accordance with PRISMA. The trial was registered with the Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022376552. Randomized controlled trials, prospective comparative studies, prospective single‐group (with pre‐ and post‐training assessment) or consensus studies that reported on the development, validation or usage of assessment tools of surgical performance in minimally invasive gynecological surgery, were included. Three independent assessors assessed study setting and validity evidence according to a contemporary framework of validity, which was adapted from Messick's validity framework. Methodological quality of included studies was assessed using the modified medical education research study quality instrument (MERSQI) checklist. Heterogeneity in data reporting on types of tools, data collection, study design, definition of expertise (novice vs. experts) and statistical values prevented a meaningful meta‐analysis.ResultsA total of 19 746 titles and abstracts were screened of which 72 articles met the inclusion criteria. A total of 37 different assessment tools were identified of which 13 represented manual global assessment tools, 13 manual procedure‐specific assessment tools and 11 automated performance metrices. Only two tools showed substantive evidence of validity. Reliability and validity per tool were provided. No assessment tools showed direct correlation between tool scores and patient related outcomes.ConclusionsExisting objective assessment tools lack evidence on predicting patient outcomes and suffer from limitations in transferability outside of the research environment, particularly for automated performance metrics. Future research should prioritize filling these gaps while integrating advanced technologies like kinematic data and AI for robust, objective surgical skill assessment within gynecological advanced surgical training programs.

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Development and validation of a simulation model for laparoscopic myomectomy

Cited by 4 publications

References 24 publications

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

Advances in gynecologic simulation: implementation, validity, and new resources

Objective assessment tools in laparoscopic or robotic‐assisted gynecological surgery: A systematic review

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