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Abstracts 1-20 ORAL POSTERS SUPPLEMENT TO The Gray Journal APRIL 2016 ■ Volume 214, Number 4 Founded 1869 YMOB_16_214n4S_COVER.indd 801 3/7/16 1:15 PM CYAN MAGENTA YELLOW BLACK PANTONE 877 C YMOB_16_214n4S_00C1.pgs 03.07.2016 12:17 SUPPLEMENT TO APRIL 2016 - Volume 214, Number 4 ORAL PRESENTATIONS S455 Abstracts 1-20 ORAL POSTERS S467 Abstracts 1-26 NON-ORAL POSTERS S481 Abstracts 27-80 VIDEO PRESENTATIONS S509 Abstracts 1-10 VIDEOFESTS S512 Abstracts 11-25 VIDEO CAFES S516 Abstracts 26-39 Cover: Wildroze/E+/Getty Images Published by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Supplement to APRIL 2016 American Journal of Obstetrics & Gynecology 1A BLACK YELLOW MAGENTA CYAN 01-80011531_P0001.pgs 03.07.2016 12:10 SOCIETY OF GYNECOLOGIC SURGEONS Founed in 1974 sgsonline.org Dear Colleagues, Friends and Guests, Welcome to sunny California! As President of the Society of Gynecologic Surgeons, it is my honor to welcome you to the 42nd Annual Scientific Meeting in Palm Springs, California April 10th-13th, 2016. Eric Sokol and the SGS Program Committee have put together what is going to be an informative, exciting and may be even a little controversial program for the scientific meeting and postgraduate courses this year. One primary component of the SGS mission is to promote excellence in gynecologic surgery. Innovation, when properly applied, is one of the key factors in furthering surgical excellence and, in that spirit, the theme of our meeting this year is “Innovative ways to improve surgical care, research, and education in gynecologic surgery.” The Keynote and TeLinde Lecturers will expound upon this topic looking at different sides of the coin, addressing how to promote what works and how to make surgery work more effectively. The SGS debate series has always been lively and this year’s will be no exception– with 4 renowned surgeons dis- cussing what the patient expects from surgical innovation. The oral and poster presentations, video sessions and round table discussions span the spectrum of gynecologic surgery (including general gynecology, oncology, minimally invasive surgery, reproductive endocrinology and urogynecology). Postgraduate courses on advanced minimally invasive surgical techniques for straight stick laparoscopy, vaginal hyster- ectomy and pelvic pain will be of interest to both the young and experienced gynecologic surgeons alike. Finally, we are sure you are going to be excited about our innovations this year for the typically early morning round table discussions. The scientific sessions and social program, as always, will provide a unique opportunity to collaborate with old friends and meet new ones. The glamour and stark beauty of the Palm Springs area – with world class golfing, amazing outdoor recreation and incredible dining all set against the stunning backdrop of the Renaissance Indian Wells Resort and Spa will leave you spellbound long after the meeting has ended. I look forward to seeing you all in Palm Springs in 2016, as we learn how and when to innovate so that we can continue to provide the best surgical care to our patients. Most Sincerely, Andrew J. Walter, MD SGS President BLACK YELLOW MAGENTA CYAN 02-80011532_P0001.pgs 03.07.2016 12:10 Oral Presentations ajog.org 1 Reasons for unplanned 30-day readmission after hysterectomy for benign disease C. Penn1, D. M. Morgan1, J. Rauh-Hain2, L. W. Rice3, S. Uppal1 1University of Michigan, Ann Arbor, MI, 2Massachusetts General Hospital, Boston, MA, 3University of Wisconsin, Madison, WI OBJECTIVES: Readmission is used as a proxy for quality of care, but there is a paucity of information regarding readmission after hysterectomy. The purpose of this study is to characterize the most common reasons for unplanned readmission following hysterectomy. MATERIALS AND METHODS: A retrospective descriptive study was performed using the American College of Surgeons National Surgical Quality Improvement Project database (ACS NSQIP) participant user file for 2012 and 2013. Information was extracted on patients undergoing hysterectomy at participating hospitals. The most common readmission diagnoses based on the International Classi- fication of Diseases, Ninth Revision, Clinical Modification were identified. Reasons for readmission were divided into 10 categories including surgical site infection, infectious reasons not including surgical site infection, surgical injury, non-infectious wound com- plications, gastrointestinal, genitourinary, venous thromboembolic, pain, medical, and other reasons. Results were stratified based on surgical approach. RESULTS: The readmission rate after hysterectomy was 2.8% (1,131/ 40,676). Rates varied significantly by surgical approach, complicating 3.7% of abdominal versus 2.6% of laparoscopic, and 2.1% of vaginal hysterectomies. Readmission rates were significantly more likely when hysterectomy was performed abdominally (OR 1.76, 95% CI 1.47-2.11) or laparoscopically (OR 1.23, 95% CI 1.04-1.45) compared with a vaginal approach. Surgical site infection, non- surgical site infections, and surgical injuries were the primary reason for admission of 56.1% of abdominal, 59.4% of laparoscopic, and 66.8% of vaginal hysterectomies. Medical complications such as cardiovascular events and venous thromboembolism accounted for 5.7% of abdominal, 6.9% of laparoscopic, and 8.8% of vaginal hysterectomies. The proportion of gastrointestinal complications was higher after abdominal hysterectomies than that observed among laparoscopic or vaginal hysterectomies. The proportion of cases readmitted for surgical complications after laparoscopic and 2 A comparison of vaginal and robotic hysterectomy vaginal hysterectomy was higher than that observed for abdominal for commonly cited relative contraindications to vaginal cases. hysterectomy CONCLUSION: The most common reason for readmission for any J. Schmitt1, D. Carranza1, J. A. Occhino1, M. Mcgree2, A. Weaver2, surgical approach is surgical site infection. More than half of all J. Gebhart1 readmissions were related to issues typically considered surgical. 1Gynecologic Surgery, Mayo Clinic, Rochester, MN, 2Biomedical Statistics Medical complications were relatively uncommon, accounting for and Informatics, Mayo Clinic, Rochester, MN less than 10% regardless of surgical approach. OBJECTIVES: Numerous relative contraindications to vaginal hyster- ectomy have been suggested including a uterine size >12 weeks DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: gestation (280 grams), no vaginal parity, desired oophorectomy at Courtney Penn: Nothing to disclose; Daniel M. Morgan: Nothing to the time of hysterectomy, obesity, endometriosis, and a history of disclose; Jose Alejandro Rauh-Hain: Nothing to disclose; Laurel W. laparotomy or cesarean delivery. The aim of this study was to Rice: Nothing to disclose; Shitanshu Uppal: Nothing to disclose. compare the patient outcome profile for each relative contraindi- cation stratified by route of surgery: vaginal or robotic. MATERIALS AND METHODS: A retrospective chart review was per- formed and a cohort of women who underwent hysterectomy for benign disease at our institution between January 1, 2009 and December 31, 2013 was created. Among the patients with the Supplement to APRIL 2016 American Journal of Obstetrics & Gynecology S455 BLACK MAGENTA CYAN 03-10878_P0001.pgs 03.07.2016 12:13 Oral Presentations ajog.org contraindication of interest, variables were compared between pa- MATERIALS AND METHODS: This is a crossover randomized study. tients with a vaginal versus robotic hysterectomy using the chi- Four surgeons were randomly assigned to 4 chairs using a 4 x 4 Latin square test or two-sample t-test. Surgical characteristics, outcomes, square model: round stool, round stool with backrest, saddle chair and complications analyzed included: utilization of intraoperative with backrest and Capisco chair. Subjective assessments of surgeon uterine debulking techniques, blood transfusion, intraoperative and discomfort were performed using a validated body discomfort survey postoperative complications including stratification for Accordion (CMDQ)(1) and workload using the SURG-TLX(2). Objective Classification 3+ complications, route conversion, operative time, postural load was quantified using inertial measurement units hospital length of stay, change in hemoglobin, and readmission rate. (IMUs)(3) with RULA limits (4). Subjective and objective assess- RESULTS: Data on 1165 patients was collected: 692 vaginal (59%) and ments of chair comfort were performed by 10-point Likert scale and 473 robotic hysterectomies (41%). Two hundred seven patients seat interface pressure mapped distributions, respectively. The pri- (18%) had a pathologic uterine weight >280 grams, 502 had an mary outcome was difference body discomfort scores. The secondary oophorectomy (unilateral or bilateral) (43%), 353 had no vaginal outcomes were difference in chair comfort scores, postural load and parity (30%), 273 had a prior cesarean delivery (23%) and 70 had a seating interface pressure mapped distribution. For each outcome preoperative diagnosis of endometriosis (6%), and 469 were obese measure, comparisons between chairs were based on fitting a linear (BMI 30 kg/m2) (40%). The outcomes below are consistently mixed model handling surgeon as a random effect and chair type as reported as (vaginal vs robotic). Uterine weight >280 grams: There a fixed effect. was a statistically significant difference in requirement of uterine RESULTS: Data was collected for 48 vaginal procedures that were debulking techniques (88% vs 73%),
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