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abstract
Objectives: To evaluate the role of minimally invasive
surgery (MIS) in gynecologic oncology fellowship training and fellows’
predictions of their use of MIS in their future practice.
Methods: All fellows-in-training in American Board of
Obstetrics and Gynecology–approved training programs were surveyed in
2012 through an online or mailed-paper survey. Data were analyzed and
compared to results of a similar 2007 survey.
Results: Of 172 fellows, 69 (40%) responded. Ninety-nine percent of respondents (n = 68) indicated that MIS was either very important or important
in gynecologic oncology, a proportion essentially unchanged from 2007
(100%). Compared to 2007, greater proportions of fellows considered
laparoscopic radical hysterectomy and node dissection for cervical
cancer (87% vs 54%; P < 0.0001) and trachelectomy and staging for cervical cancer (83% vs 32%; P < 0.0001) appropriate for MIS. Of the respondents, 92% believed that maximum or some emphasis
should be placed on robotic-assisted surgery and 89% on traditional
laparoscopy during fellowship training. Ten percent rated their
fellowship training in laparoendoscopic single-site surgery as very poor; 44% said that the question was not applicable.
Most respondents (60%) in 2012 performed at least 11 procedures per
month, whereas most respondents (45%) in 2007 performed 6 to 10
procedures per month (P = 0.005). All respondents at
institutions where robotic surgery was used were allowed to operate at
the robotic console, and 63% of respondents reported that in
robotic-assisted surgery cases when a fellow sat at the robot, the
fellow performed more than 50% of the case at the console.
Conclusions: These findings indicate that MIS in
gynecologic oncology is here to stay. Fellowship programs should develop
a systematic approach to training in MIS and in individual MIS
platforms as they become more prevalent. Fellowship programs should also
develop and apply an objective assessment of minimum proficiency in MIS
to ensure that programs are adequately preparing trainees.
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