Factors that Influence Applicants Pursuing a Fellowship in Minimally Invasive Gynecologic Surgery

Traylor, Jessica; Friedman, J.; Runge, M.; Tsai, Susan; Chaudhari, A.; Milad, Magdy P.

doi:10.1016/j.jmig.2019.08.006

Cited by 10 publications

(8 citation statements)

References 7 publications

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“…It is not just recent OB/GYN graduates who do not feel prepared to perform gynecologic surgery procedures independently [2,20]. Fellowship directors view recent OB/ GYN residency graduates as underprepared for independent surgical practice [23].…”

Section: Discussionmentioning

confidence: 99%

“…The fellowship in minimally invasive gynecologic surgery (MIGS) was established in 2001 to provide advanced training in endoscopic gynecologic procedures and has evolved to encompass all benign gynecologic pathology including pelvic pain, uterine myomas, and pelvic floor disorders [1,2]. Since its inception, the subspecialty has grown with the number of MIGS fellowship programs increasing from 5 sites in 2001 to 23 in 2008 [3].…”

mentioning

confidence: 99%

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Barriers to Referral to Fellowship-trained Minimally Invasive Gynecologic Surgery Subspecialists

Delara¹,

Misal²,

Yi³

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: To determine patterns and barriers for referral to fellowship-trained minimally invasive gynecologic surgeons. Design: Questionnaire. Setting: United States and its territories and Canada. Participants: Actively practicing general obstetrician/gynecologists (OB/GYNs). Interventions: Internet-based survey. Measurements and Main Results: Of 157 respondents, 144 (91.7%) general OB/GYNs were included. Subspecialty fellowship training resulted in the exclusion of 13 ( 8.3%) respondents. A total of 86 respondents (59.7%) considered referral to fellowship-trained minimally invasive gynecologic surgery (MIGS) subspecialists. The top 3 cited reasons for nonreferral were adequate residency training (n = 84, 58.3%), preference for continuity of care (n = 48, 33.3%), and preference for referral to other subspecialists (n = 46, 31.9%). The top 3 cited reasons for referral to MIGS subspecialists were complex pathology (n = 92, 63.9%), complex medical and/or surgical history (n = 76, 52.8%), and out of scope of practice (n = 53, 36.8%). If providers required intraoperative assistance, respondents consulted an OB/GYN colleague with comparable training (n = 50, 34.7%), gynecologic oncologist (n = 48, 33.3%), or non-OB/GYN surgical subspecialist (n = 33, 22.9%). Factors that were not associated with the decision to refer to MIGS subspecialists included years in practice (p = .13), additional training experiences beyond residency (p = .45), and number of hysterectomies performed by laparotomy (p = .69). Selfreported high-volume surgeons (p <.01) were less likely to refer. In contrast, providers who self-reported as low-volume surgeons (p = .02) and were aware of MIGS subspecialists in the community (p <.01) were more likely to consider referral. Respondents reported using a laparoscopic approach to hysterectomy most frequently (n = 79, 54.9%). In contrast, 36.8% preferred the laparoscopic route for themselves or their partner, whereas 48.6% preferred the vaginal approach. Conclusion: Most of the general OB/GYNs would consider referral to fellowship-trained MIGS subspecialists. Providers who reported adequate residency training and those who preferred continuity of care or referral to other surgical subspecialists were less likely to refer to MIGS subspecialists.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Barriers to Referral to Fellowship-trained Minimally Invasive Gynecologic Surgery Subspecialists

Delara¹,

Misal²,

Yi³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…43 Specialization might also help surgeons to gain confidence for complex MIS procedures, 44 as residents often feel uncomfortable with MIS procedures on completion of residency training. 45,46 Different programs showed that fellowships or specialization tracks led to higher volumes. 47,48 For robotic surgery, our study showed that both hospital and gynecological volumes increased, which shows a good first implementation of this new technique.…”

Section: Discussionmentioning

confidence: 99%

Decline in surgeon volume after successful implementation of advanced laparoscopic surgery in gynecology: An undesired side effect?

Tummers

Hoebink

Driessen

et al. 2021

Acta Obstet Gynecol Scand

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“…However, one included study [16] has found that the operation time of LM was similar to that of AM. The duration of the operation is affected by various factors such as anesthesia, the operation of the medical staff, and the proficiency of the surgeons [34][35][36], which may result in inconsistent results. However, theoretically the LM is more refined, and the requirements for the proficiency of clinicians are significantly higher [37], so it is understandable that LM Fig.…”

Section: Discussionmentioning

confidence: 99%

The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis

Chen

Yang

et al. 2020

BMC Surg

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Background: Abdominal myomectomy (AM) and laparoscopic myomectomy (LM) are commonly see surgery for the uterine fibroids, several randomized controlled trials (RCTs) have compared the role of AM and LM, the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of LM versus AM in patients with uterine fibroids. Methods: We searched PubMed et al. databases from inception date to July 31, 2019 for RCTs that compared LM versus AM in patients with uterine fibroids. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for each outcome by means of fixed-or random-effects model. Results: Twelve RCTs with a total of 1783 patients were identified, with 887 patients for and 897 patients for AM. Compared with AM, LM could significantly decrease the blood loss (OR = − 29.78, 95% CI-57.62-− 0.95), shorten the duration of postoperative ileus (OR = − 10.91, 95% CI-18.72-− 3.11), reduce the length of hospital stay (OR = − 1.57, 95% CI-2.05-− 1.08), but LM was associated with longer duration of operation (OR = 16.10, 95% CI 6.52-25.67) and higher medical cost (OR = 17.61, 95% CI 7.34-27.88). Conclusions: LM seems to be a better choice for patients with uterine fibroids, more related studies are needed to identify the role of LM and AM for the treatment of uterine fibroids.

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Factors that Influence Applicants Pursuing a Fellowship in Minimally Invasive Gynecologic Surgery

Cited by 10 publications

References 7 publications

Barriers to Referral to Fellowship-trained Minimally Invasive Gynecologic Surgery Subspecialists

Barriers to Referral to Fellowship-trained Minimally Invasive Gynecologic Surgery Subspecialists

Decline in surgeon volume after successful implementation of advanced laparoscopic surgery in gynecology: An undesired side effect?

The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis

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