LAUSR

Study Objective To compare patient characteristics and surgical outcomes for surgeries performed by fellowship-trained gynecologic surgeons (MIGS) to OB/GYNs without additional training (Generalists). Design Literature review using PubMed/Medline. Setting Academic university and community hospitals. Patients or Participants Eight retrospective cohort studies including total of 8,888 patients undergoing minimally invasive surgery by MIGS and Generalists Interventions Compare patient BMI, uterine weight, and prior surgical history; evaluate difference in surgical complexity, operative times, blood loss, length of hospital stay, occurrence of complications, hospital costs. Measurements and Main Results Majority of studies included benign hysterectomies performed over an average of 3.75 years (range 1-9 years). Fellowship training included MIGS; only one study included gynecologic-oncologists and urogynecologists. Compared to Generalists, MIGS operated on patients with higher BMI (OR 2.030 for BMI 40+), greater uterine weight (649.9 g v. 320.7 g, p=0.01), and a history of prior abdominal surgeries (42.7% vs 17.2%; p=0.001). MIGS performed more difficult procedures related to resection of endometriosis (22.9% vs. 4.4%, p MIGS had significantly shorter operative times, lower blood loss during surgery, and decreased length of stay after surgery. Patient and hospital charges were lower for surgeries performed by MIGS (patient cost: $28,063 vs. $36,612, p Majority of the studies show a decrease or no difference in rate of total, postoperative or intraoperative complications with MIGS. Conclusion MIGS fellowship training is associated with improved perioperative outcomes, despite the increase in surgical complexity. This finding indicates that surgical volume is not the only determinant of outcomes. Unlike other surgical residencies, this higher level of technical ability is not consistently obtained in the current structure of OB-GYN residency, underlining the importance of additional training, which ultimately may be required for those who wish to practice gynecologic surgery in the future.