A Novel Technique Using Ultrasonic Shears Versus Traditional Methods of Reduction of Bilateral Labia Minora Hypertrophy: A Retrospective Case-Control Study

ABSTRACT Introduction To compare the clinical outcomes of bilateral labia minora hypertrophy reduction using ultrasonic shears versus traditional methods. Materials and Methods In this retrospective study, we evaluate the surgical outcomes of 11 women who underwent bilateral labia minora hypertrophy reduction using ultrasonic shears to 14 women who underwent the same procedure using various traditional methods between January 1, 2015 and February 29, 2020 in a single center. The primary outcomes evaluated are total operative time, estimated blood loss, and postoperative pain. Secondary outcomes include postoperative complications and total admission time. The statistical analyses used were exact Wilconxon Rank and Fisher’s exact test. Results 25 total bilateral labiaplasty procedures were included in the analysis. 11 procedures were performed using ultrasonic shears and 14 were performed using traditional methods. The mean reduction operative time for the ultrasonic shears technique when compared with traditional methods was 43.25 minutes (22.82 minutes versus 66.07 minutes, P = .0002). A statistically significant but non-clinically significant difference in estimated blood loss was noted. No statistically significant differences existed with postoperative pain score, total admission time, or postoperative complications. Conclusions Ultrasonic shears significantly reduce the time needed for the reduction of bilateral labia minora hypertrophy and therefore should be considered by surgeons as a useful tool in increasing the efficiency of this procedure. </jats:sec

The Impact of Robotic-Assisted Technology on Attitudes of Host Nation Individuals Participating in Pacific Partnership 2018: Improving Partnerships Through Technology

Abstract The USNS Mercy (T-AH 19) on Pacific Partnership 2018 was the first mobile, expeditionary platform to utilize the da Vinci Surgical System. Using a de-identified, web-based survey, the impact of this new technology on Pacific Partnership 2018 on the attitudes of host nation surgeons was examined.</jats:p

Evaluating the Impact of Office Hysteroscopy in a Military Treatment Facility

Abstract Introduction Office hysteroscopy has become a cornerstone of modern gynecologic care through the advent of advanced technology and emphasis on an efficient healthcare system. In 2017, Medicare announced an increase in office hysteroscopy reimbursement by 237%, giving an incentive for gynecologists to move from the operating room into the clinic. The U.S. military medical system needs more cost-effective and efficient healthcare, given that the cost of military healthcare increased by 130% between 2000 and 2012 (accounting for 10% or $52 billion of the Department of Defense budget). Within our institution, we have moved to conducting a regularly scheduled outpatient hysteroscopy clinic. Increased healthcare costs, decreased available operating room time, and efforts to boost patient and provider satisfaction drove the change. Materials and Methods After institutional review board approval, we performed a retrospective observational cost-benefit analysis of 235 outpatient and 45 inpatient records that included female military healthcare beneficiaries age 18 or older who had diagnostic or operative hysteroscopy performed in the operating room or office setting from January 2015 to October 2018. We specifically focused on diagnostic hysteroscopy, hysteroscopic biopsy and polypectomy, and hysteroscopic foreign body removal (intrauterine device removal). We then compared admission time, procedure time, reimbursement, and cost for each of the hysteroscopic procedure groups to yield a total cost-benefit value (TCBV). TCBV was defined as cost savings plus difference in reimbursement rate. Results This study analyzes the costs and benefits of a regularly scheduled hysteroscopy clinic within the U.S. military medical system. We performed a cost-benefit analysis that indicated a substantial difference between clinic and operating room TCBV, total relative value units or reimbursement rates, and total patient care time. We found the average admission time for an inpatient procedure was 6.23 hours compared to our standard 1-hour clinic time. The average success rate for procedure completion in the clinic was 89$64,220, $159,940, and$66,709 for diagnostic hysteroscopy, hysteroscopic biopsy and polypectomy, and hysteroscopic foreign body (intrauterine device) removal, respectively. Conclusions Compared to traditional operating room hysteroscopy, we were able to demonstrate reduced costs with increased reimbursement while performing the same scope of care for patients undergoing office hysteroscopy. Decreased total time in performing office hysteroscopy suggests the potential benefit of increased patient and provider satisfaction. Our study indicated substantial incentive for military gynecologists to incorporate office hysteroscopy into their practice given the increased relative value units generated. Our office hysteroscopy protocol is discussed to encourage other military facilities to follow in our footsteps. </jats:sec

Effect of validated skills simulation on operating room performance in obstetrics and gynecology residents: a randomized controlled trial

OBJECTIVES: To estimate whether training on previously validated laparoscopic skill stations translates into improved technical performance in the operating room