The Future of the Gynecologic Surgeon: Rationale for and Steps toward Subspecialization of Complex Gynecologic Surgery

Differences in Exposure to Minimally Invasive Surgery in a Sample of United States Obstetrics and Gynecology Residents

OBJECTIVE

 The objective of this study was to assess the exposure to minimally invasive gynecologic surgery (MIGS) techniques among senior (third and fourth year) Obstetrics and Gynecology residents in the United States.

METHODS

 We conducted an online cross-sectional survey among senior residents who completed a 19-item questionnaire regarding their exposure to laparoscopic and robotic cases and techniques and their access to their simulation. We performed a comparison among these residents, grouped based on the four geographical regions of the United States.

RESULTS

 Senior residents, on average, performed 4.0 MIGS cases (standard deviation (SD) ±2.5), 1.0 two-handed laparoscopy (SD ±1.0), and 1.5 robotic cases (SD ±1.5) per week. The exposure to challenging skills such as extracorporeal and intracorporeal suturing and laparoendoscopic single site (LESS) surgery per week was minimal and did not vary across the nation (p=0.99, p=0.06, p=0.52, respectively). Access to dual consoles increased the number of robotic cases performed per week (p=0.01). While residents of all regions had equal access to laparoscopic box trainers (p=0.81) and laparoscopic simulators (p=0.22), residents of the southern region had less access to robotic simulators (p=0.04).

CONCLUSION

 The number of MIGS cases performed by residents did not differ nationwide. However, exposure to advanced aspects of endoscopy training was minimal. The presence of a fellowship or type of teaching environment did not alter the number of cases performed by residents. Residents performed a greater number of robotic cases with the presence of dual consoles.