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Maignien C, Bourdon M, Parpex G, Ferreux L, Patrat C, Bordonne C, Marcellin L, Chapron C, Santulli P. Endometriosis-related infertility: severe pain symptoms do not impact assisted reproductive technology outcomes. Hum Reprod 2024; 39:346-354. [PMID: 38142239 DOI: 10.1093/humrep/dead252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/06/2023] [Indexed: 12/25/2023] Open
Abstract
STUDY QUESTION Do severe endometriosis-related painful symptoms impact ART live birth rates? SUMMARY ANSWER Severe pain symptoms are not associated with reduced ART live birth rates in endometriosis patients. WHAT IS KNOWN ALREADY ART is currently recognized as one of the main therapeutic options to manage endometriosis-related infertility. Presently, no data exist in the literature regarding the association between the core symptom of the disease, e.g. pain and ART reproductive outcomes. STUDY DESIGN, SIZE, DURATION Observational cohort study of 354 endometriosis patients, who underwent ART at a tertiary care university hospital, between October 2014 and October 2021. Diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging, and histologically confirmed in women who had a previous history of endometriosis surgery (n = 127, 35.9%). PARTICIPANTS/MATERIALS, SETTING, METHODS The intensity of painful symptoms related to dysmenorrhea (DM), dyspareunia (DP), noncyclic chronic pelvic pain, gastrointestinal (GI) pain, or lower urinary tract pain was evaluated using a 10-point visual analog scale (VAS), before ART. Severe pain was defined as having a VAS of 7 or higher for at least one symptom. The main outcome measure was the cumulative live birth rate (CLBR) per patient. We analyzed the impact of endometriosis-related painful symptoms on ART live births using univariable and multivariate analysis. MAIN RESULTS AND THE ROLE OF CHANCE Three hundred and fifty-four endometriosis patients underwent 711 ART cycles. The mean age of the population was 33.8 ± 3.7 years, and the mean duration of infertility was 3.6 ± 2.1 years. The distribution of the endometriosis phenotypes was 3.1% superficial endometriosis, 8.2% ovarian endometrioma, and 88.7% deep infiltrating endometriosis. The mean VAS scores for DM, DP, and GI pain symptoms were 6.6 ± 2.7, 3.4 ± 3.1, and 3.1 ± 3.6, respectively. Two hundred and forty-two patients (68.4%) had severe pain symptoms. The CLBR per patient was 63.8% (226/354). Neither the mean VAS scores for the various painful symptoms nor the proportion of patients displaying severe pain differed significantly between patients who had a live birth and those who had not, based on univariate and multivariate analyses (P = 0.229). The only significant factors associated with negative ART live births were age >35 years (P < 0.001) and anti-Müllerian hormone levels <1.2 ng/ml (P < 0.001). LIMITATIONS, REASONS FOR CAUTION The diagnosis of endometriosis was based on imaging rather than surgery. This limitation is, however, inherent to the design of most studies on endometriosis patients reverting to ART first. WIDER IMPLICATIONS OF THE FINDINGS Rather than considering a single argument such as pain, the decision-making process for choosing between ART and surgery in infertile endometriosis patients should be based on a multitude of aspects, including the patient's choice, the associated infertility factors, the endometriosis phenotypes, and the efficiency of medical therapies in regard to pain symptoms, through an individualized approach guided by a multidisciplinary team of experts. STUDY FUNDING/COMPETING INTEREST(S) No funding; no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C Maignien
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - M Bourdon
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - G Parpex
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - L Ferreux
- Faculté de Santé, Université de Paris, Paris, France
- Department of Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Patrat
- Faculté de Santé, Université de Paris, Paris, France
- Department of Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Bordonne
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Radiology (Professor Dion), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France
| | - L Marcellin
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - C Chapron
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - P Santulli
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
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Learning Curve for Ultrasound Assessment of Myometrial Infiltration in Endometrial Cancer Visualizing Videoclips: Potential Implications for Training. Diagnostics (Basel) 2023; 13:diagnostics13030425. [PMID: 36766530 PMCID: PMC9914064 DOI: 10.3390/diagnostics13030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Diagnostic accuracy for estimating myometrial infiltration by ultrasound in endometrial cancer requires experience. The objective of this study is to determine the learning curve (LC) for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS). METHODS Five trainees (one staff radiologist and four fourth-year OB/GYN residents) participated in this study. All trainees had experience in performing TVS, but none of them had specific training on the assessment of myometrial infiltration. Trainees were given one specific lecture about the topic, and then they observed videoclips from 10 cases explained by the trainer. After this, all trainees visualized 45 videoclips of uterine ultrasound scans of endometrial cancer cases. The assessment of myometrial infiltration was based on the subjective impression. Definitive histology was used as a reference standard. Trainees stated whether myometrial infiltration was ≥50% or <50%. LC-CUSUM and standard CUSUM graphics were plotted to determine how many cases were needed to reach competence, allowing a mistake rate of 15%. RESULTS All trainees completed the study. LC-CUSUM graphics showed that three trainees reached competence at the 33rd, 35th and 36th case, respectively. All three of them kept the process under control after reaching competence. One trainee reached competence but did not maintain it in the cumulative analysis. One trainee did not reach competence. CONCLUSION Our study suggests that 30-40 cases would be needed to be trained for assessing myometrial infiltration by TVS by visual interpretation of videoclips by most trainees.
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Raiza LCP, Bianchi PHDM, Piccinato CDA, Podgaec S. Sonographic signs of deep infiltrative endometriosis among women submitted to routine transvaginal sonography: clinical and imaging aspects. EINSTEIN-SAO PAULO 2022; 20:eAO0086. [DOI: 10.31744/einstein_journal/2022ao0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
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Recker F, Dugar M, Böckenhoff P, Gembruch U, Geipel A. Development and implementation of a comprehensive postgraduate ultrasound curriculum for residents in obstetrics and gynecology: a feasibility study. Arch Gynecol Obstet 2022; 306:1045-1051. [PMID: 35430714 PMCID: PMC9470601 DOI: 10.1007/s00404-022-06554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND In obstetric and gynecological practice, ultrasound is the essential diagnostic tool. Nevertheless, few clinics have standardized and structured training curricula for young obstetricians in the field of obstetric and gynecological ultrasound. Since ultrasound is best learned hands-on in small supervised groups, we developed and implemented a comprehensive ultrasound curriculum for all postgraduate residents of our department using a peer-teaching concept. METHODS We used Kern's six-step model of curricular development comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback. RESULTS Assistant physicians in the 1st and 2nd year of training received a theoretical and practical ultrasound basic course (six modules) in addition to their obligatory clinic rotations. The six main topics were prioritized according to service relevance and included the main features according to DEGUM, EBCOG and ISUOG. The units focused on a three-level training based on the AMEE levels: theoretical knowledge, well-founded theoretical knowledge and basic practical skills under guidance and self-employment of practical skills. CONCLUSION Structured and standardized sonographic training allows young gynecology and obstetrics residents to conceptually grasp and practically implement topic-related themes. Furthermore, the course concept demonstrates the high inter-rater agreement among DEGUM-certified examiners. More research is needed to analyze the learning outcomes for residents and the improvement of the patient's outcome by establishing such an ultrasound curriculum.
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Affiliation(s)
- Florian Recker
- Department for Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Martina Dugar
- Department for Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Paul Böckenhoff
- Department for Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department for Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Annegret Geipel
- Department for Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
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Bottéro C, Dubernard G, Dreyfus M, Cortet M, Philip CA. Evaluation of an e-learning program for the diagnosis of rectosigmoid endometriosis with rectal water contrast transvaginal ultrasonography (rectosonography). Eur J Obstet Gynecol Reprod Biol 2022; 278:45-50. [PMID: 36115259 DOI: 10.1016/j.ejogrb.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
This study aimed to evaluate the value of an e-learning program for the diagnosis of rectosigmoid endometriosis lesions using rectal water contrast transvaginal ultrasonography (rectosonography/RSG). Theoretical RSG training using videos with a commentary was offered online to healthcare professionals involved in ultrasound screening for endometriosis. A test (without correction) with 24 RSG video loops was used to assess the participants' baseline level before the training and their improvement afterwards. If the success rate post-training was below 80 %, the participant could start over with another series of 24 videos. Between February and June 2020, thirty participants took the training course (of which 80 % were obstetrics-gynaecology residents). The e-learning program resulted in a significant performance increase in the diagnosis of rectosigmoid endometriosis lesions, with a higher test success rate after the training compared to before (74.4 % and 63.6 % respectively; +10.8 %; 95 % CI [6,6; 15]; p < 0.001). Significant improvement was also observed regarding the overall skills involved in the ultrasound diagnosis of deep infiltrating endometriosis (+9.2 %; p < 0.001), the accurate diagnosis of the height of bowel lesions (+14.7 %; p < 0.001) and uterosacral ligament lesions (+8%; p < 0.005). In conclusion, our e-learning program led to a significant improvement of the diagnostic performance of digestive endometriosis using transvaginal ultrasound with intrarectal water contrast (rectosonography). Adding feedback to the post-test video loops could further increase the efficacy of the e-learning training.
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Affiliation(s)
- Célia Bottéro
- Gynaecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Université Lyon 1, France; Gynaecology Department, CHU Nimes, Université de Montpellier, France
| | - Gil Dubernard
- Gynaecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Université Lyon 1, France; LabTAU INSERM 1032, Université Lyon 1, France
| | - Marion Dreyfus
- Gynaecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Université Lyon 1, France; Gynaecology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Marion Cortet
- Gynaecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Université Lyon 1, France; LabTAU INSERM 1032, Université Lyon 1, France
| | - Charles-André Philip
- Gynaecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Université Lyon 1, France; LabTAU INSERM 1032, Université Lyon 1, France.
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Philip CA, Sandré A, de Saint-Hilaire P, Cortet M, Dubernard G. Learning Curve for the Detection of Deep Infiltrating Endometriosis and Adenomyosis with 3-D Transvaginal Water Contrast Sonography. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1328-1335. [PMID: 35469632 DOI: 10.1016/j.ultrasmedbio.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Three-dimensional rectosonography (RSG) is a transvaginal sonography technique using rectal water contrast and 3-D acquisitions. The main points of interest of 3-D RSG could be its easy accessibility and its quick learning curve, especially with respect to rectosigmoid lesions. The objective of this prospective observational study was to assess the learning curve of 3-D RSG for the diagnosis of rectosigmoid lesions and for various other locations of deep endometriosis (DE), endometriomas and adenomyosis. From April 2017 to November 2017, 116 patients with suspected pelvic endometriosis were referred to the Croix-Rousse University Hospital, and those who underwent 3-D RSG were included in our study. After a short training period, four residents were asked to perform 3-D RSG by themselves. Each procedure was systematically controlled immediately afterward by a single expert sonographer. The success of the procedure involved the correct identification of various locations of endometriosis (rectosigmoid, uterosacral ligament, retrocervical space, vagina, bladder and ovaries) and adenomyosis, using the expert sonographer's examination as the reference technique. The learning curve was generated using these data and assessed using the Learning Curve Cumulative Summation Test (LC-CUSUM) method. The pooled LC-CUSUM revealed that the required level of achievement was reached after 24 3-D RSGs were performed for the diagnosis of rectosigmoid lesions. All four residents were significantly competent in diagnosing rectosigmoid lesions at the end of their training period, with an α risk <0.05 (T1, p = 0.03; T2, p = 0.0002; T3, p = 0.05; T4, p = 0.02). The LC-CUSUM analysis confirmed that competency was achieved for vaginal DE, torus uterinum DE, US DE, bladder DE, endometriomas and adenomyosis within 17, 27, 38, 19, 17 and 33 scans, respectively. This study provides evidence that the skills required to diagnose endometriosis lesions and adenomyosis with 3-D RSG can be acquired after a brief learning period in an expert center.
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Affiliation(s)
- Charles-André Philip
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.
| | - Amélie Sandré
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre de Saint-Hilaire
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France
| | - Marion Cortet
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Gil Dubernard
- Obstetrics and Gynecology Department, Croix-Rousse University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
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Balcacer P, Johnson SC. Reply to The 'Speckle Sign' in the Diagnosis of Posterior Compartment Endometriosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:791. [PMID: 33913185 DOI: 10.1002/jum.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Patricia Balcacer
- Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samuel C Johnson
- Department of Diagnostic Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Verhaeghe C, El Hachem H, Inchboard L, Corroenne R, Dreux C, Jeanneteau P, Legendre G, Descamps P, Saulnier P, May-Panloup P, Bouet PE. Assessment of operator performance during oocyte retrievals: residents' learning curve and continuous monitoring of senior physicians. BMC MEDICAL EDUCATION 2021; 21:193. [PMID: 33823830 PMCID: PMC8025573 DOI: 10.1186/s12909-021-02615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. After acquisition of the skills, the cumulative summation test (CUSUM test) allows to monitor the maintenance of the required level over time. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR. METHODS We performed a retrospective study at Angers university hospital between May 2017 and September 2018. Seven Ob/Gyn residents and 5 senior physicians were included, and all OR performed during that time (n = 690) were analyzed. The performance index assessed was the oocyte retrieval rate (ORR), defined as the ratio of oocytes retrieved to follicles aspirated. We used the LC CUSUM test to analyze the learning curves of residents, and the CUSUM test to monitor the performance of senior physicians. An ORR ≥50% in 60% of retrievals was defined as the threshold for clinical proficiency. RESULTS Six hundred seventy-four oocyte retrieval (OR) were included: 315 were performed by residents, 220 by senior physicians, and 139 by both residents and physicians (mixed retrievals). Four residents (57%) reached the threshold after aspirating 82, 67, 53 and 46 ovaries, respectively. The mean number of ovaries aspirated in order to reach clinical proficiency was 62, and the mean number of weeks needed was 21. The duration of the learning period varied between 26 and 80 days. Two senior physicians (40%) remained proficient across the duration of the study, while two physicians (40%) had one statistically "suboptimal" OR, and one physician (20%) had two suboptimal retrievals. CONCLUSION There is a large variability in the duration of the learning period and the number of procedures needed for a resident to master OR. Senior physicians maintain an adequate performance.
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Affiliation(s)
- C Verhaeghe
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France.
| | - H El Hachem
- Department of Reproductive Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - L Inchboard
- Clinical Research Center, Angers University Hospital, Angers, France
| | - R Corroenne
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - C Dreux
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Jeanneteau
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - G Legendre
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Descamps
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Saulnier
- Clinical Research Center, Angers University Hospital, Angers, France
| | - P May-Panloup
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P E Bouet
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
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Ferrero S, Barra F, Scala C, Condous G. Ultrasonography for bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2021; 71:38-50. [DOI: 10.1016/j.bpobgyn.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023]
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Early Learning Curve in the Assessment of Deep Pelvic Endometriosis for Ultrasound and Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8757281. [PMID: 33029527 PMCID: PMC7537705 DOI: 10.1155/2020/8757281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
Purpose We aimed to compare the learning curves of an ultrasound trainee (obstetrics and gynecology resident) and a radiology trainee when assessing pelvic endometriosis. Methods Consecutive patients with suspected endometriosis were prospectively enrolled in a tertiary center. They underwent an ultrasound and magnetic resonance imaging preoperatively, which was reported according to the International Deep Endometriosis Analysis (IDEA) group consensus. Trainees reported on deep endometriosis (DE), endometriomas, frozen pelvis, and adenomyosis. Using the Kappa agreement, their findings were compared against laparoscopy/histology and expert findings. The learning curve was considered positive when performance improved over time and indeterminate in all other cases. Results Reports from thirty-five women were divided chronologically into 3 equal blocks to assess the learning curve. For ultrasound, trainee versus expert showed a positive learning curve in overall pelvic DE assessment. There was an excellent agreement for adenomyosis (Kappa = 1.00, p = 0.09), frozen pelvis (Kappa = 0.90, p = 0.01), bowel (Kappa = 1.00, p = 0.01), and bladder DE assessment (Kappa = 1.00, p = 0.01). Endometrioma and uterosacral ligament assessment showed an indeterminate curve. For radiology, trainee versus expert showed a positive curve when detecting adenomyosis (Kappa = 0.42, p = 0.09) and bladder DE (Kappa = 1.00, p = 0.01). The assessment of endometriomas, frozen pelvis, overall pelvic DE, bowel, and uterosacral ligament DE showed indeterminate curve. Agreement between trainees and laparoscopy/histology showed a positive curve for bladder (both) and frozen pelvis (ultrasound only). Conclusion A positive learning curve can be seen in some areas of pelvic endometriosis mapping after as little as 35 cases, but a bigger caseload is required to demonstrate the curve in full. The ultrasound trainee had positive learning curves in more anatomical locations (bladder, adenomyosis, overall bowel DE, frozen pelvis) than the radiology trainee (bladder, adenomyosis), which could be down to individual factors, differences in training, or the imaging method itself.
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Aas-Eng MK, Salama M, Sevelda U, Ruesch C, Nemeth Z, Hudelist G. Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:264-268. [PMID: 31236990 DOI: 10.1002/uog.20379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/19/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate how many examinations it takes to be able to identify the pelvic parts of the ureters on transvaginal sonography (TVS). METHODS This was a prospective study including consecutive women attending a gynecological outpatient clinic in a tertiary referral setting. Prior to commencement of the study, three trainees, with a focus on gynecological surgery and TVS but with no experience in identifying ureters, each observed an expert examiner performing 10 routine TVS examinations, including identification of both ureters. All were standardized gynecological TVS examinations, with visualization of the pelvic part of both ureters. Consecutive women were then examined, first by the expert, unobserved by the trainees, and then by one of the three trainees, in the presence of the expert. To ensure that identification of the pelvic parts of the ureters could be incorporated feasibly into routine gynecological TVS in a tertiary referral setting, a time limit of 150 s was set for successful identification of each ureter. A successful examination was defined by identifying both ureters within the time limit. The number of women examined by each trainee was determined by how quickly they achieved proficiency, which was evaluated using the learning curve cumulative summation (LC-CUSUM) score. RESULTS Between January 2017 and June 2017, a total of 140 women were recruited for the study, with 135 patients being included in the final analysis. The three trainees were able to identify the right ureter after a maximum of 48 (range, 34-48) TVS examinations, and the left ureter after a maximum of 47 (range, 27-47) TVS examinations. CONCLUSIONS Sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 40-50 TVS examinations. Detection of the ureters is a feasible part of the TVS workup of patients attending a clinic in a tertiary referral center. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M K Aas-Eng
- Department of Gynaecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - M Salama
- Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria
| | - U Sevelda
- Department of Gynaecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
| | - C Ruesch
- Department of Gynaecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
| | - Z Nemeth
- Department of Gynaecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
| | - G Hudelist
- Department of Gynaecology, Certified Center for Endometriosis and Pelvic Pain, Hospital St John of God, Vienna, Austria
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Using Simulation to Define the Learning Curve for the Digital Cervical Examination. Obstet Gynecol 2019; 134 Suppl 1:1S-8S. [PMID: 31568034 DOI: 10.1097/aog.0000000000003433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To assess how skill in the digital cervical examination is acquired in medical students. METHODS In a longitudinal study, medical students completed 200 simulated cervical examinations. We performed regressions of each student's cumulative accuracy using the linear, power, and sigmoidal models to determine best fit. We also constructed multilevel models to determine the influence of dilation and effacement on accuracy and to determine whether the starting level and rate of learning varied between individuals. To assess skill decay, we assessed accuracy at 1, 2, and 5 months after training. We defined the amount of sustained accuracy needed to achieve competence using cumulative summation analyses and determined the amount of practice needed to reach this level of skill. RESULTS Twenty-five medical students participated. The median (interquartile range) of cumulative accuracy at the end of the study was 69% (65-78) for dilation and 80% (76-91) for effacement. The sigmoidal model had the best fit. All students achieved competence during the study. The multilevel models showed that accuracy decreased with higher dilation and lower effacement and found that starting level and rate of learning varied between individuals. Maximal accuracy in both dilation and effacement was seen after 150 repetitions. Accuracy of the medical students persisted for 1 month for dilation and 2 months for effacement. The average±SD number of repetitions needed to achieve competence was 89±46 (range 35-195) for dilation and 48±38 (range 11-174) for effacement. DISCUSSION Based on the variability in skill between individuals and the rate of skill acquisition and decay, we feel that a competence-based rather than time-based approach is most appropriate, that trainee performance should be monitored both during and after training, and that 150 repetitions, or more, should be included in any digital cervical examination simulation regimen.
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Guerriero S, Pascual MA, Ajossa S, Rodriguez I, Zajicek M, Rolla M, Rams Llop N, Yulzari V, Bardin R, Buonomo F, Comparetto O, Perniciano M, Saba L, Mais V, Alcazar JL. Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:262-269. [PMID: 30426587 DOI: 10.1002/uog.20176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE). METHODS Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE. RESULTS The trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE. CONCLUSIONS The suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - I Rodriguez
- Unidad Epidemiología y Estadística, Departamento de Obstetricia, Ginecología y Reproducción, Hospital Universitario Quirón Dexeus, Barcelona, Spain
| | - M Zajicek
- Obstetrics and Gynecology Ultrasound Unit at the Chaim Sheba Medical Center, Tel-Hashomer, Israel affiliated to Tel-Aviv University, Israel
| | - M Rolla
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - N Rams Llop
- Secció d'Ecografia Servei de Ginecologia i Obstetricia Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Yulzari
- Ob/Gyn Ultrasonic Imaging Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - R Bardin
- Hellen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - F Buonomo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - O Comparetto
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - M Perniciano
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - V Mais
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Moura APC, Ribeiro HSAA, Bernardo WM, Simões R, Torres US, D’Ippolito G, Bazot M, Ribeiro PAAG. Accuracy of transvaginal sonography versus magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: Systematic review and meta-analysis. PLoS One 2019; 14:e0214842. [PMID: 30964888 PMCID: PMC6456198 DOI: 10.1371/journal.pone.0214842] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Intestinal endometriosis is considered the most severe form of deep endometriosis, the rectosigmoid being involved in about 90% of cases of bowel infiltration. Transvaginal sonography (TVS) and magnetic resonance imaging (MRI) have been used for noninvasive diagnosis and preoperative mapping of rectosigmoid endometriosis (RE), but no consensus has been reached so far regarding which method is the most accurate in this setting. OBJECTIVE We aimed at performing a systematic review and meta-analysis to compare the accuracy of TVS versus MRI in the diagnosis of RE in a same population. METHODS A systematic review was conducted in accordance with the PRISMA guidelines. Studies were identified by searching the MEDLINE, Embase, and LILACS databases, as well the reference lists of retrieved articles, through February 2019. We included all cross-sectional studies that evaluated the accuracy of TVS versus MRI in the diagnosis of RE within a same sample of subjects and that used surgical findings with histological confirmation as the gold standard. The QUADAS-2 instrument was used to evaluate study quality. Sensitivity, specificity, positive likelihood ratios (LR+), and negative likelihood ratios (LR-) for the diagnosis of RE were calculated. This study is registered with PROSPERO, number CRD42017064378. RESULTS Eight studies (n = 1132) were included in the meta-analysis. The pooled sensitivity, specificity, LR+, and LR- values of MRI for RE were 90% (95% CI, 87-92%), 96% (95% CI, 94-97%), 17.26 (95% CI, 3.57-83.50), and 0.15 (95% CI, 0.10-0.23); values of TVS were 90% [95% CI, 87-92%], 96% (95% CI, 94-97%), 20.66 (95% CI, 8.71-49.00) and 0.12 (95% CI, 0.08-0.20), respectively. Areas under the S-ROC curves (AUC) showed no statistically significant differences between MRI (AUC = 0.948) and TVS (AUC = 0.930) in the diagnosis of RE (P = 0.13). Moreover, considering the average prevalence among the studies of 47.3%, both methods demonstrated similarly high positive post-test probabilities (93.9% for TVS and 94.8% for MRI), and the combined use of them yielded a post-test probability of 99.6%. CONCLUSION MRI and TVS have similarly high accuracy and positive post-test probabilities in the noninvasive diagnosis of RE. Combination of MRI and TVS may increase even further the positive post-test probabilities to near 100%.
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Affiliation(s)
| | | | | | - Ricardo Simões
- Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | | | - Giuseppe D’Ippolito
- Grupo Fleury, Sao Paulo, Brazil
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marc Bazot
- Department of Radiology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris, Paris, France
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Lee Y, Shin H, Kim C, Lee I, Choi HJ. Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners: A STROBE-compliant article. Medicine (Baltimore) 2019; 98:e15191. [PMID: 30946386 PMCID: PMC6456141 DOI: 10.1097/md.0000000000015191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to determine the value of cumulative summation (CUSUM) analysis in assessing the proficiency of novice practitioners in estimating the left ventricular ejection fraction (EF).Seven novice practitioners with no echocardiography experience were recruited in this observational study. Each practitioner assessed EF from echocardiographic video files of 100 cases, one by one, and received feedback and teaching. We obtained a CUSUM score through comparison of the gold standard values of EF and the EF values determined by the practitioners. Then, the practitioners underwent the same test 4 weeks later, except without feedback and teaching, using echocardiographic video files from 100 other cases.The mean number of visual estimation cases required to pass the learning curve (LC)-CUSUM test was 56.3 ± 9.1 (95% CI 47.8-64.7). The LC-CUSUM average of the 7 novice practitioners showed improvement in visual estimation skill, with an average acceptable level achieved after a mean experience of 55 cases. In the test performed after 4 weeks, 5 of the 7 novice practitioners showed significantly good overall agreement. All novice practitioners had a kappa coefficient greater than .8, and significant and almost perfect agreement was observed. All the participants exhibited a percentage of correct answers greater than 81%.We found that the novice practitioners could acquire an acceptable level of skill for estimating EF with short-term, self-learning-focused echocardiographic training.
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Affiliation(s)
- Yoonje Lee
- Department of Emergency Medicine, College of Medicine, Korea University Anam Hospital, Seoul
| | - Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Inhye Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
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Sansone A, De Rosa N, Giampaolino P, Guida M, Laganà AS, Di Carlo C. Effects of etonogestrel implant on quality of life, sexual function, and pelvic pain in women suffering from endometriosis: results from a multicenter, prospective, observational study. Arch Gynecol Obstet 2018; 298:731-736. [PMID: 30074068 DOI: 10.1007/s00404-018-4851-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 07/03/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Progestins are successfully employed as treatment for endometriosis. Our study evaluates the effects of the etonogestrel (ENG) implant on pelvic pain, quality of life, and sexual function in women requiring long-term reversible contraception and presenting ovarian cysts of probable endometriotic origin. METHODS We enrolled 25 women asking for contraception with the ENG implant and presenting a cyst with the ultrasound features of an endometrioma and pain symptoms. Patients were interviewed on pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria) using a VAS score (0-10), on quality of life (QoL) using the Short Form-36 questionnaire, and on sexual activity using the Female Sexual Function Index (FSFI) questionnaire before inserting the implant (T0) and after 6 (T1) and 12 months (T2). RESULTS We found a significant decrease in dysmenorrhea and dyspareunia VAS scores comparing baseline scores to 6 and 12 months. After 12 months, the bodily pain, general health, vitality, social functioning, and mental health domains of the QoL score were significantly improved. The total FSFI score results increased in comparison with baseline both at 6 and 12 months. In particular, we highlighted a significant improvement in desire, satisfaction, and pain domains already at 6 months; the arousal domain improved only after 12 months. Finally, mean diameters of endometrioma-like cysts were not changed after 12 months of treatment. CONCLUSIONS Etonogestrel implants seem to be able to reduce pelvic pain, improve sexual function, and quality of life in patients with ovarian cysts suspected of endometriotic origin.
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Affiliation(s)
- Anna Sansone
- Department of Public Health and Preventive Medicine, University of Naples Federico II, Via Sergio Pansini, Naples, Italy
| | - Nicoletta De Rosa
- Department of Neurosciences and Reproductive Sciences, University of Naples Federico II, Via Sergio Pansini, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health and Preventive Medicine, University of Naples Federico II, Via Sergio Pansini, Naples, Italy.
| | - Maurizio Guida
- Department of Obstetrics and Gynecology, University of Medicine and Surgery of Salerno, Via Allende, Salerno, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy
| | - Costantino Di Carlo
- Department of Experimental and Clinical Medicine Unit of Obstetrics, Gynecology University of Catanzaro "Magna Graecia", Viale Europa, Catanzaro, Italy
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[Performances and place of sonography in the diagnostic of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:185-199. [PMID: 29544709 DOI: 10.1016/j.gofs.2018.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 12/27/2022]
Abstract
Endometriosis is difficult to diagnose clinically. Transvaginal sonography (TVS) is a procedure that is known to be operator-dependent, which mean that published evidences has to be balanced with the level of the sonographer that produced the data. The objective of this publication was to assess the performances of the sonography in the diagnosis of endometriosis in order to establish the French national recommendations. We searched the MEDLINE database for publication from January 2000 to September 2017 using keywords associated with endometriosis and sonography. Eighty-four trial and reviews published in English or French were included. Ovarian endometrioma can usually be diagnosed by a non-expert sonographer, especially when its aspect is typical. In case of an ovarian cyst with atypical presentation, it is recommended to control the sonography by a referent or to perform an MRI. In menopaused women, any ovarian cyst should be considered as a cancer until proven otherwise. In the diagnosis of posterior deep invasive endometriosis (DIE), TVS with sensitivity and specificity of 96 and 99% respectively, seems at least equivalent if not superior to MRI. However, these performances are related to expert sonographers. To reach sufficient efficiency in posterior DIE, the estimated learning curve for a sonographer is 44 cases. When posterior DIE is suspected, we recommend proposing a TVS "performed by an expert" or a MRI "at least interpreted by an expert". In anterior DIE, TVS has a good specificity (100%), but its sensitivity is poor in the literature (64%). TVS is therefore not able to eliminate the diagnosis. However a renal ultrasound should be proposed each time a urinary endometriosis is confirmed, and should be considered whenever posterior DIE is diagnosed especially the lesion is superior to 3cm.
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Daraï E, Bendifallah S, Chabbert-Buffet N, Golfier F. [Creation of expert centers on endometriosis]. Presse Med 2017; 46:1218-1222. [PMID: 29169709 DOI: 10.1016/j.lpm.2017.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022] Open
Abstract
Endometriosis is a frequent pathology with a high incidence of deep infiltrating endometriosis and complex forms that can affect 20% of patients with endometriosis. The incidence of infertility associated with endometriosis can reach 50%. The complexity of care requires the creation of expert centers working in networks with general practitioners. Criteria for defining these expert centers are being drawn up, based on structural criteria (multidisciplinary consultation meeting), links with medical assistance structures for procreation and activity criteria for severe and complex forms (number of interventions per center and per surgeon).
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Affiliation(s)
- Emile Daraï
- Université Pierre et Marie Curie (UPMC), Assistance publique des hôpitaux de Paris, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de La Chine, 75020 Paris 6, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UMPC), 75020 Paris, France; UMRS-938, Paris 6, 75012, Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France.
| | - Sofiane Bendifallah
- Université Pierre et Marie Curie (UPMC), Assistance publique des hôpitaux de Paris, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de La Chine, 75020 Paris 6, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UMPC), 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- Université Pierre et Marie Curie (UPMC), Assistance publique des hôpitaux de Paris, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de La Chine, 75020 Paris 6, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UMPC), 75020 Paris, France; UMRS-938, Paris 6, 75012, Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France
| | - François Golfier
- CHU de Lyon, service de gynécologie-obstétrique, 69000 Lyon, France
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Eisenberg VH, Alcazar JL, Arbib N, Schiff E, Achiron R, Goldenberg M, Soriano D. Applying a statistical method in transvaginal ultrasound training: lessons from the learning curve cumulative summation test (LC-CUSUM) for endometriosis mapping. ACTA ACUST UNITED AC 2017; 14:19. [PMID: 29046621 PMCID: PMC5626798 DOI: 10.1186/s10397-017-1022-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Methods available for assessing the learning curve, such as a predefined number of procedures or direct mentoring are lacking. Our aim was to describe the use of a statistical method to identify the minimal training length of an experienced sonographer, newly trained in deep infiltrating endometriosis (DIE) mapping by evaluating the learning curve of transvaginal ultrasound (TVUS) in the preoperative assessment of endometriosis. METHODS A retrospective study in a tertiary referral center for endometriosis. Reports and stored data from TVUS scans performed by one operator with training in general gynecological ultrasound, but not in endometriosis mapping, were analyzed retrospectively for patients who subsequently underwent laparoscopy, which served as a reference standard. The performance of TVUS was assessed for the following sites: endometriomas, bladder, vagina, pouch of Douglas, bowel and uterosacral ligaments, and correlated with laparoscopic findings. Sensitivity, specificity, PPV, NPV, and accuracy were calculated, and the operator's diagnostic performance was assessed using the learning curve cumulative summation test (LC-CUSUM). RESULTS Data from 94 women were available for analysis. The learning curve using the LC-CUSUM graph showed that the sonographer reached the predefined level of proficiency in detecting endometriosis lesions after 20, 26, 32, 31, 38, and 44 examinations for endometriomas, bladder nodules, vaginal nodules, pouch of Douglas obliteration, bowel nodules, and uterosacral ligament nodules, respectively. CONCLUSIONS LC-CUSUM allows monitoring of individual performance during the learning process of new methodologies. This study shows that a sonographer trained in general gynecologic ultrasonography, who devotes time to learn TVUS for DIE mapping, can achieve proficiency for diagnosing the major types of endometriotic lesions after examining less than 50 patients who subsequently undergo surgery in a training setting.
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Affiliation(s)
- Vered H Eisenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, 52621 Ramat Gan, Israel
| | - Juan L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, 52621 Ramat Gan, Israel
| | - Eyal Schiff
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, 52621 Ramat Gan, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, 52621 Ramat Gan, Israel
| | - Motti Goldenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, 52621 Ramat Gan, Israel
| | - David Soriano
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, 52621 Ramat Gan, Israel
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Added Value of Assessing Adnexal Masses with Advanced MRI Techniques. BIOMED RESEARCH INTERNATIONAL 2015; 2015:785206. [PMID: 26413542 PMCID: PMC4564594 DOI: 10.1155/2015/785206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/23/2014] [Accepted: 12/07/2014] [Indexed: 12/16/2022]
Abstract
This review will present the added value of perfusion and diffusion MR sequences to characterize adnexal masses. These two functional MR techniques are readily available in routine clinical practice. We will describe the acquisition parameters and a method of analysis to optimize their added value compared with conventional images. We will then propose a model of interpretation that combines the anatomical and morphological information from conventional MRI sequences with the functional information provided by perfusion and diffusion weighted sequences.
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Millischer AE, Salomon LJ, Santulli P, Borghese B, Dousset B, Chapron C. Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:109-117. [PMID: 25358293 DOI: 10.1002/uog.14712] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/08/2014] [Accepted: 10/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) and ultrasound scanning complement each other in screening for and diagnosis of endometriosis. Fusion imaging, also known as real-time virtual sonography, is a new technique that uses magnetic navigation and computer software for the synchronized display of real-time ultrasound and multiplanar reconstructed MR images. Our aim was to evaluate the feasibility and ability of fusion imaging to assess the main anatomical sites of deep infiltrating endometriosis (DIE) in patients with suspected active endometriosis. METHODS This prospective study was conducted over a 1-month period in patients referred to a trained radiologist for an ultrasound-based evaluation for endometriosis. Patients with a prior pelvic MRI examination within the past year were offered fusion imaging, in addition to the standard evaluation. All MRI examinations were performed on a 1.5-T MRI machine equipped with a body phased-array coil. The MRI protocol included acquisition of at least two fast spin-echo T2-weighted orthogonal planes. The Digital Imaging Communications in Medicine dataset acquired at the time of the MRI examination was loaded into the fusion system and displayed together with the ultrasound image on the same monitor. The sets of images were then synchronized manually using one plane and one anatomical reference point. The ability of this combined image to identify and assess the main anatomical sites of pelvic endometriosis (uterosacral ligaments, posterior vaginal fornix, rectum, ureters and bladder) was evaluated and compared with that of standard B-mode ultrasound and MRI. RESULTS Over the study period, 100 patients were referred for ultrasound examination because of endometriosis. Among them were 20 patients (median age, 35 (range, 27-49) years) who had undergone MRI examination within the past year, with a median (range) time interval between MRI and ultrasound examination of 171 (1-350) days. All 20 patients consented to undergo additional evaluation by fusion imaging. However, in three (15%) cases, fusion imaging was not technically possible because of changes since the initial MRI examination resulting from either interval surgery (n = 2; 10%) or pregnancy (n = 1; 5%). Data acquisition, matching and fusion imaging were performed in under 10 min in each of the other 17 cases. The overall ability of each technique to identify and assess the main anatomical landmarks of endometriosis was as follows: uterosacral ligaments: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); posterior vaginal fornix: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); rectum: ultrasound, 100% (17/17); MRI, 82.3% (14/17); fusion imaging, 100% (17/17); ureters: ultrasound, 0%; MRI, 100% (34/34); fusion imaging, 100% (34/34); and bladder: ultrasound, 100%; MRI, 100%; fusion imaging, 100%. CONCLUSION Fusion imaging is feasible for the assessment of endometriotic lesions. Because it combines information from both ultrasound and MRI techniques, fusion imaging allows better identification of the main anatomical sites of DIE and has the potential to improve the performance of ultrasound and MRI examination.
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Affiliation(s)
- A-E Millischer
- Radiology, Centre de Radiologie Bachaumont IMPC-Paris, Paris, France
| | - L J Salomon
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université Paris Descartes, Maternité; Société Française pour l'Amélioration des Pratiques Echographiques, SFAPE, Paris, France
| | - P Santulli
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Gynecology, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Paris, France
- Gynecology, Université Paris Descartes, Faculté de Médecine, EA 1833, ERTi, AP-HP, CHU Cochin, Paris, France
| | - B Borghese
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Gynecology, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Paris, France
| | - B Dousset
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Service de Chirurgie Viscerale Hopital Cochin-Paris, Paris, France
| | - C Chapron
- Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Gynecology, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Paris, France
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Dessolle L. Quality control of training and performance in embryo transfer: time to broadcast LC CUSUM and CUSUM tests. Hum Reprod 2014; 29:2353-4. [PMID: 25035433 DOI: 10.1093/humrep/deu181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lionel Dessolle
- CHU Brest, service de gynécologie obstétrique et médecine de la reproduction, Hôpital Morvan, Brest 29200, France
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Tammaa A, Fritzer N, Strunk G, Krell A, Salzer H, Hudelist G. Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum. Hum Reprod 2014; 29:1199-204. [DOI: 10.1093/humrep/deu078] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Dessolle L, Leperlier F, Biau DJ, Fréour T, Barrière P. Proficiency in oocyte retrieval assessed by the learning curve cumulative summation test. Reprod Biomed Online 2014; 29:187-92. [PMID: 24832373 DOI: 10.1016/j.rbmo.2014.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022]
Abstract
The number of procedures required for a trainee to reach proficiency in oocyte retrieval and the criteria applied to define performance are not well defined. To evaluate the learning curve of oocyte retrieval, this study prospectively evaluated three trainees over 6 months. Oocyte retrieval was monitored by the learning curve-cumulative summation test (LC-CUSUM), a specific statistical tool designed to indicate when a predefined level of performance is reached. Oocytes were retrieved from one ovary by the trainee and from the second ovary by a senior operator in a randomized manner. The main outcome measure was the ratio of oocytes collected and follicles aspirated. A trainee's ratio of ≥ 80% of the senior operator's defined success. From 17 to >50 procedures were necessary for the trainees to reach the predefined level of performance. Cumulative summation tests implemented after the learning phase confirmed that performance was maintained. The present study confirms the large variability in acquiring proficiency for surgical procedures. It provides an exportable model for a quantitative tailored monitoring of the learning curve and for continuous monitoring of performance in oocyte retrieval.
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Affiliation(s)
- Lionel Dessolle
- Service de Biologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Nantes, 38, Bd Jean Monnet, 44093 Nantes Cedex 1, France.
| | - Florence Leperlier
- Service de Biologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Nantes, 38, Bd Jean Monnet, 44093 Nantes Cedex 1, France
| | - David J Biau
- Département de Chirurgie Orthopédique, APHP - Hôpital Cochin, Université René Descartes, Paris, France
| | - Thomas Fréour
- Service de Biologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Nantes, 38, Bd Jean Monnet, 44093 Nantes Cedex 1, France
| | - Paul Barrière
- Service de Biologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Nantes, 38, Bd Jean Monnet, 44093 Nantes Cedex 1, France
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25
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Tolsgaard MG, Ringsted C, Dreisler E, Klemmensen A, Loft A, Sorensen JL, Ottesen B, Tabor A. Reliable and valid assessment of ultrasound operator competence in obstetrics and gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:437-43. [PMID: 23996613 DOI: 10.1002/uog.13198] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/05/2013] [Accepted: 08/19/2013] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To explore the reliability and validity of a recently developed instrument for assessment of ultrasound operator competence, the Objective Structured Assessment of Ultrasound Skills (OSAUS). METHODS Three groups of 10 doctors with different levels of ultrasound experience in obstetrics and gynecology were included. The novices had less than 1 month of experience, the intermediate group had 12-60 months of experience and the senior participants were all consultants. Fifteen participants performed transabdominal fetal biometry and the other 15 participants performed systematic transvaginal gynecological ultrasound scans. All scans were video-recorded and assessed by two blinded consultants using the OSAUS scale. The OSAUS scores were compared between the groups using the Kruskal-Wallis test, and pass/fail scores were determined using the contrasting-groups method of standard setting. RESULTS For the transabdominal fetal biometry examinations, the mean ± SD OSAUS scores of the novices, intermediates and senior participants were 1.5 ± 0.4, 3.3 ± 0.6 and 4.4 ± 0.4, respectively (P = 0.003). For the systematic transvaginal scans, the mean ± SD OSAUS scores of the novices, intermediates and senior participants were 1.8 ± 0.2, 3.1 ± 0.1 and 3.9 ± 0.5, respectively (P = 0.003). Post-hoc comparisons showed significant differences between each of the groups for both types of scans. The pass/fail score was 2.5 for the transvaginal scan and 3.0 for the transabdominal biometry examinations. The inter-rater reliability was 0.89. CONCLUSIONS Ultrasound competence can be assessed in a reliable and valid way using the OSAUS scale. The pass/fail scores may be used to help determine when trainees are qualified for independent practice.
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Affiliation(s)
- M G Tolsgaard
- Department of Obstetrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Tolsgaard MG, Rasmussen MB, Tappert C, Sundler M, Sorensen JL, Ottesen B, Ringsted C, Tabor A. Which factors are associated with trainees' confidence in performing obstetric and gynecological ultrasound examinations? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:444-51. [PMID: 24105723 DOI: 10.1002/uog.13211] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To explore the association between clinical training characteristics and trainees' level of confidence in performing ultrasound scans independently. METHODS A cross-sectional e-survey was distributed to members of the national societies of junior obstetricians/gynecologists in Denmark, Sweden and Norway (n = 973). Multiple linear regression models were used to explore the effect that amount of time spent in specialized ultrasound units and clinical experience had on trainees' confidence in performing ultrasonography independently. Exploratory factor analysis was used to identify factors that contributed to trainees' confidence in performing ultrasonography. Trainees' ultrasound confidence was finally compared with their expected levels of performance. RESULTS Of the 682 respondents (response rate 70.1%), 621 met the inclusion criteria. Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently (P < 0.001). Trainees required more than 24 months of clinical experience and 12-24 days of training in specialized ultrasound units in order to feel confident about performing transvaginal and transabdominal ultrasound scans independently. Three factors were related to ultrasound confidence: technical aspects, image perception and integration of scan into patient care. There were significant differences between trainees' level of confidence and their expected levels of performance (P < 0.001). CONCLUSIONS Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently. Discrepancies between trainees' confidence and their expected levels of performance raised concerns about the adequacy of current ultrasound training programs.
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Affiliation(s)
- M G Tolsgaard
- Department of Obstetrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Rodriguez A, Guillén JJ, López MJ, Vassena R, Coll O, Vernaeve V. Learning curves in 3-dimensional sonographic follicle monitoring during controlled ovarian stimulation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:649-655. [PMID: 24658944 DOI: 10.7863/ultra.33.4.649] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Three-dimensional (3D) sonographically based automated volume calculation (SonoAVC; GE Healthcare, Zipf, Austria) is being introduced in folliculometry during ovarian stimulation; however, clear training assessments in this technique are lacking. The learning curve-cumulative summation (LC-CUSUM) test provides a quantitative tool to determine when a trainee has learned a procedure. The aim of this prospective study was to assess 3D SonoAVC LC-CUSUM curves in folliculometry. METHODS Analyses were performed on 98 oocyte donors by capturing the ovarian image in 3D and applying the 3D SonoAVC software during ovarian stimulation cycles. Each patient was scanned by an expert operator and by a trainee. Independent LC-CUSUM tests for 4 follicular diameters tracked the competency of 3 trainees in 3D SonoAVC. RESULTS We found that the numbers of sonographic examinations required by the 3 trainees to identify the correct number of follicles of 10 mm or larger were 38, 32, and 28, respectively; for follicles of 14 mm or larger, they were 29, 28, and 28; for follicles of 18 mm or larger, they were 24, 19, and 27; and for follicles of 21 mm or larger, they were 29, 19, and 24. CONCLUSIONS A variable number of procedures are needed to reach proficiency in 3D SonoAVC, even for trained 2-dimensional sonographers. Assessment of learning curves should be implemented when incorporating 3D SonoAVC in reproduction units.
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Affiliation(s)
| | | | | | - Rita Vassena
- DVM, Clinica Eugin, Travessera de les Corts 322, 08029 Barcelona Spain.
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Lee YK, Biau DJ, Yoon BH, Kim TY, Ha YC, Koo KH. Learning curve of acetabular cup positioning in total hip arthroplasty using a cumulative summation test for learning curve (LC-CUSUM). J Arthroplasty 2014; 29:586-9. [PMID: 23998991 DOI: 10.1016/j.arth.2013.07.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 07/12/2013] [Accepted: 07/21/2013] [Indexed: 02/01/2023] Open
Abstract
Despite advances in surgical techniques and instrumentation, optimal cup positioning in total hip arthroplasty (THA) is challenging with a limited accuracy. We evaluated whether a learning curve exists for the optimal cup positioning, using the LC-CUSUM test (Learning curve cumulative summation test). We evaluated the first 100 consecutive THA performed by two surgeons, who had a year of fellowship training in the same teaching hospital. A learning curve of cup positioning was plotted in each series using the LC-CUSUM score. There was no significant difference of numbers of outlier between two surgeons (P = 0.079). Both surgeons completed the learning curve of optimal cup positioning before 50 procedures, and maintained competence. A substantial learning period is necessary in the optimal positioning of an acetabular cup.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - David J Biau
- Department of Orthopaedic Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, South Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Dongan-gu, Anyang, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam, South Korea
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Yim GW, Kim SW, Nam EJ, Kim S, Kim YT. Learning curve analysis of robot-assisted radical hysterectomy for cervical cancer: initial experience at a single institution. J Gynecol Oncol 2013; 24:303-12. [PMID: 24167665 PMCID: PMC3805910 DOI: 10.3802/jgo.2013.24.4.303] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the learning curve and perioperative outcomes of robot-assisted laparoscopic procedure for cervical cancer. METHODS A series of 65 cases of robot-assisted laparoscopic radical hysterectomies with bilateral pelvic lymph node dissection for early stage cervical cancer were included. Demographic data and various perioperative parameters including docking time, console time, and total operative time were reviewed from the prospectively collected database. Console time was set as a surrogate marker for surgical competency, in addition to surgical outcomes. The learning curve was evaluated using cumulative summation method. RESULTS The mean operative time was 190 minutes (range, 117 to 350 minutes). Two unique phases of the learning curve were derived using cumulative summation analysis; phase 1 (the initial learning curve of 28 cases), and phase 2 (the improvement phase of subsequent cases in which more challenging cases were managed). Docking and console times were significantly decreased after the first 28 cases compared with the latter cases (5 minutes vs. 4 minutes for docking time, 160 minutes vs. 134 minutes for console time; p<0.001 and p<0.001, respectively). There was a significant reduction in blood loss during operation (225 mL vs. 100 mL, p<0.001) and early postoperative complication rates (28% vs. 8.1%, p=0.003) in phase 2. No conversion to laparotomy occurred. CONCLUSION Improvement of surgical performance in robot-assisted surgery for cervical cancer can be achieved after 28 cases. The two phases identified by cumulative summation analysis showed significant reduction in operative time, blood loss, and complication rates in the latter phase of learning curve.
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Affiliation(s)
- Ga Won Yim
- Institute of Women's Life Medical Science, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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The Vestibular Schwannoma Surgery Learning Curve Mapped by the Cumulative Summation Test for Learning Curve. Otol Neurotol 2013; 34:1469-75. [DOI: 10.1097/mao.0b013e31829bfc54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Proficiency in oocyte retrieval: how many procedures are necessary for training? Fertil Steril 2011; 96:e143; author reply e144. [DOI: 10.1016/j.fertnstert.2011.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
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Reply of the Authors. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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