By developing educational courses in minimally invasive gynecology (MIG) we hope to increase the use of MIG and reduce morbidity and complication rates associated with these procedures.
Practice Gap: There is a fundamental lack of minimally invasive gynecological surgical training during physicians’ formal education, and difficulty in acquiring formal training once in medical practice. Gynecologic Surgeons who desire to advance their skills and knowledge in laparoscopic surgery need a forum from which to learn from experts in the field and the opportunity to put newly gained knowledge into practice. Additionally, most gynecologists do not have a sufficient annual volume of benign gynecologic procedures to maintain proficiency. The learning curve for laparoscopic hysterectomy proficiency has been reported to be as high as 75 cases and for robotic hysterectomy proficiency to be as high as 91 cases. Educational forums like the AAGL Annual Global Congress on MIGS provide formal educational and training opportunities, such as surgical tutorials and cadaver labs, which provide access for gynecologists to gain the experience and proficiency needed, post-residency, to perform advanced laparoscopic, robotic, hysteroscopic, abdominal and vaginal surgery for complex, benign gynecologic conditions. These conditions include uterine fibroids, advanced endometriosis, benign ovarian neoplasms, ovarian remnants, and chronic pelvic pain.
Best practice would have our learners evaluating and appropriately selecting the appropriate medical and/or surgical treatment plans for women presenting with complex, benign gynecologic conditions such as abnormal uterine bleeding, symptomatic uterine fibroids, chronic pelvic pain, and/or endometriosis. This would include gaining expertise in complex surgical pathology, appropriately managing patients with complicated medical conditions, extensive surgical histories, high BMIs, etc. Minimally invasive techniques have been shown to reduce post-surgical complication rates, reduce hospital length of stay, decrease intraoperative blood loss, reduce postoperative pain, and reduce morbidity and mortality rates associated with traditional procedures.
Gap Analysis: MIG procedures are aimed at preserving the highest possible quality of life for women by using smaller and fewer incisions, reducing pain and trauma to the body, and enabling quicker recovery. Yet, the ability to perform these more patient-friendly procedures requires most gynecologists to commit to post-residency training since they are not routinely taught during formal training. This requires a commitment to lifelong learning to attain specialized skills in pelvic surgery and because of the development of new technologies and instrumentation. Since training varies and is often performed in a manner that is not standardized and subject to bias, it is vital that gynecologists achieve procedural mastery through good surgical coaching and feedback.
Planning the Intervention: The goal of our intervention is that through continuing medical education (CME), organized into didactic and hands-on sessions, gynecologists will acquire and/or advance their skills in MIG. An open forum will follow with discussion designed to stimulate interaction between faculty and learners.
- Create awareness of the role MIG plays and review the current literature relative to MIGS
- Host hands-on labs that will allow each participant to practice MIG techniques on cadavers
- Offer surgeons with minimally invasive experience the opportunity to refine their skills and technique in both robotic assisted and traditional laparoscopic surgery
- Review of the fundamentals of laparoscopic suturing, from basic to advanced
- Transfer skill to course participants through didactic lectures, video presentations, demonstrations, and supervised wet lab surgeries
- Expectations are that future courses will be organized to spread awareness and transfer skills in MIG to other gynecologists, who are willing to commit to this lifelong process
- To maximize the return of this year’s Congress, upon completion participants will be requested to explain how their newly acquired knowledge and skills will impact their practice
Objectives: At the conclusion of the course, participants should be able to:
- Apply the latest developments in minimally invasive healthcare for women
- Demonstrate the skills needed for proficiency
- Employ minimally invasive surgical techniques such as laparoscopic hysterectomy, myomectomy, pelvic floor repair, treatment of endometriosis and advanced hysteroscopic techniques
- Acquire hands-on experience in the anatomy laboratory as well as laboratories focused on laparoscopic suturing, hysteroscopy, robotic surgery, and single-port surgery
- Apply the latest advances in research and techniques in the field of minimally invasive gynecologic surgery
- Evaluate data presented to determine the best methods for practice of gynecologic medicine
- Demonstrate and enhance their presentation and publication skills with a hands-on workshop
- Explore the practice that exists in the intersections between surgical gynecology and other disciplines such as obstetrics, oncology, reproductive medicine, pediatrics, and adolescent medicine
- Identify complications which may occur during minimally invasive surgery in order to better prevent, avoid, and manage complications
- Provide culturally, ethnically, and sociologically inclusive clinical care
Additional Barriers and Possible Solutions:
Barrier: MIG is relatively difficult to learn, and all procedures require accurate surgical skills and experience to perform. Therefore, the course participants may not be able to utilize the techniques immediately upon completion of this course.
Possible Solution: Continue to provide physicians with additional education and the resources they need to elevate their practice in gynecology while increasing their skills in minimally invasive gynecology.
Barrier: Literature states that “Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology exist and these differences are not fully accounted for by patient, socioeconomic, or healthcare infrastructure factors. Initiatives that incentivize hiring surgeons trained to perform complex gynecologic surgery, standardized pathways for route of surgery, quality improvement focused on increased hospital MIS volume, and hospital-based public reporting of MIS volume data may be of benefit for minimizing disparities.”(1)
Possible Solution: “Initiatives to reduce disparities need to address racism, implicit bias, and healthcare structural issues that perpetuate disparities.”(1) AAGL continues to include content to address cultural considerations in care, disparities in care, and implicit bias when planning accredited education with the hope that learners develop and implement strategies to address unintended biases in decision making and health care disparities.
(1) Barnes WA, Carter-Brooks CM, Wu CZ, Acosta DA, Vargas MV. Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology. Curr Opin Obstet Gynecol. 2021 Aug 1;33(4):279-287. doi: 10.1097/GCO.0000000000000719. PMID: 34016820.