The impact of fellowship surgical training on operative time and patient morbidity during robotics-assisted sacrocolpopexy

Carter-Brooks, Charelle M.; Du, Angela L.; Bonidie, Michael; Shepherd, Jonathan

doi:10.1007/s00192-017-3468-3

Cited by 6 publications

(3 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 87%

“…Increasingly, reconstructive and POP procedures are being performed by high-volume surgeons in general and those fellowship trained in female pelvic medicine and reconstructive surgery, with the former reflected in this cohort, where more than 75% of cases were performed by surgeons who perform more than 50 surgical procedures for POP per year. [17][18][19] Previous studies have suggested that both fellowship training and high annual volume of cases are associated with lower rates of injury. [20][21][22] Although we were not able to determine which health care providers were fellowship trained, we did find that surgical procedures performed by surgeons with fewer than 50 POP surgical procedures per year were more likely to be associated with GUTI, particularly if the surgical volume was fewer than 12 per year.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Sheyn¹,

Gupta

Boyd

et al. 2022

Female Pelvic Med Reconstr Surg

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Importance The rate of genitourinary tract injury (GUTI) following pelvic organ prolapse (POP) surgery is presently ill-defined and based on relatively small trials with short follow-up time. Given the potential for higher risk of injury with POP, a better understanding of this type of injury is important for patient counseling. Objectives The objective of this study was to identify the incidence and risk factors of GUTI related to POP surgery. Study Design Women undergoing POP surgery between 2010 and 2019 were identified using Current Procedural Terminology codes in the Premier Healthcare Database. The primary outcome was GUTI, defined as bladder or ureteral injury, and vesicovaginal or ureterovaginal fistula within 1 year of surgery. Genitourinary tract injury was identified using International Classification of Diseases and Current Procedural Terminology codes. Patients were divided into those with and without GUTI. Differences between groups were evaluated using the Student t test, Wilcoxon rank-sum test, and Fisher exact test as appropriate. Multivariable logistic regression was used to evaluate the independent predictors of GUTI. Results One hundred thirty-nine thousand one hundred fifty-eight surgical procedures for POP were captured between 2010 and 2019. The rate of GUTI was 1.10%: 0.48% bladder, 0.64% ureteral injuries, and 0.01% fistulas. The most significant variables associated with any GUTI were as follows: adhesiolysis (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.07–6.51), blood transfusion (aOR, 3.67; 95% CI, 1.34–10.04), and low-volume surgeons (<12 cases per year) (aOR, 1.68; 95% CI, 1.60–1.77), nonurologic or gynecologic surgeon specialty (aOR, 1.62; 95% CI, 1.49–2.00), and uterosacral suspension (aOR, 1.30; 95% CI, 1.13–1.49). Conclusions The rate of GUTI following POP surgery is lower than has previously been reported. Surgeon experience and specialty and surgical approach may affect GUTI incidence.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Sheyn¹,

Gupta

Boyd

et al. 2022

Female Pelvic Med Reconstr Surg

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“…Patients are frequently concerned about the impact of surgical trainees and the negative impact they may have on their surgery. Carter-Brooks et al, performed a retrospective review of 208 RSC and noted that although fellows took about 30 minutes longer, there was no impact on the overall complication or recurrence rates as compared to cases without fellows (46). In addition, Crane et al, noted that although total robot docked times were longer for trainees (23 minutes), the overall average hysterectomy and sacrocolpopexy times were not different when trainees were involved in patient care (47).…”

Section: Ancillary Factors Impacting Efficacymentioning

confidence: 99%

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

Schachar¹,

Matthews²

2020

Transl Androl Urol

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The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females.Sacrocolpopexy is the "gold standard" repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques.The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients.Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.

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Updates in Minimally Invasive Approaches to Apical Pelvic Organ Prolapse Repair

Schachar

Matthews

2019

Curr Obstet Gynecol Rep

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The impact of fellowship surgical training on operative time and patient morbidity during robotics-assisted sacrocolpopexy

Abstract: When an expert surgeon operated together with a fellow, operative time increased by 34 min without increasing prolapse recurrence or complications.

Cited by 6 publications

References 22 publications

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Incidence and Risk Factors for Genitourinary Tract Injury Within 1 Year After Surgery for Pelvic Organ Prolapse

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

Updates in Minimally Invasive Approaches to Apical Pelvic Organ Prolapse Repair

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