INTRODUCTION:

The goal of this study was to assess the effect of the addition of fellowship-trained faculty in minimally invasive gynecologic surgery to a community-based obstetrics and gynecology resident training program in an inner-city location.

METHODS:

A retrospective chart review was conducted from August 1, 2011, through August 25, 2014, to extract surgical cases covered by gynecology residents in an inner-city community teaching hospital. This includes total and supracervical hysterectomies performed through laparotomy and laparoscopy. Additionally, adnexal surgery was also analyzed. Surgery performed outside of the teaching hospital, where residents rotate for limited time periods, were excluded as well as oncology cases.

RESULTS:

A total of 544 hysterectomies were initially identified; 425 met inclusion criteria. Additionally there were 83 myomectomies and 469 procedures for adnexal indications identified. Total surgical volume with the addition of such minimally invasive gynecologic surgery faculty increased: hysterectomies increased by 63.3%, myomectomies increased by 77.3%, and a 26.5% increase in surgery on adnexa. In the 2 years without minimally invasive surgery faculty, 66.9% (162/242) procedures were performed through laparotomy for hysterectomy and 33.5% (81/242) through minimally invasive surgery (total laparoscopic hysterectomy, laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy), with one conversion to laparotomy. In the year with the addition of minimally invasive surgery faculty to pre-existing faculty, hysterectomies performed through laparotomy comprised 54.1% (99/183) and hysterectomies performed with minimally invasive surgery comprised 45.9% (84/183). Laparoscopic myomectomies were performed only during the time with such faculty. The effect was also noticeable on trends for laparoscopic ovarian cystectomy and for salpingectomy for ectopic pregnancies.

CONCLUSION:

The addition of faculty with a focus on minimally invasive surgical techniques to a community residency training program in an inner-city setting can help increase surgical volume, training, and access to minimally invasive surgery techniques for residents in training.