How Many Supervised Colpotomies Should General Surgeons Do to Safely Engage in Transvaginal NOTES?

Dimitrios Stefanidis, MD, PhD, David Desilets, MD, Vimal Narula, MD, Robert Fanelli, MD, Daniel J Scott, MD, Kurt Roberts, MD

Carolinas Healthcare System, Yale University, multiple

Introduction: The transvaginal (TV) access is one of the most commonly used approaches to NOTES procedures. Unfortunately, training and or credentialing guidelines that ensure the safety of this approach do not exist. The objective of this study was to establish the learning curve and credentialing requirements of the TV approach based on expert opinion.

Methods: A web-based anonymous survey was created based on author consensus and distributed to gynecologists experienced in the technique at three academic institutions and NOSCAR members using SurveyMonkey. Respondents were asked to report their prior experience with TV access, their learning curve with the technique, any encountered complications, and minimum number of suggested supervised procedures prior to independent practice. They were also asked to identify the fundamental components of a training course for this technique.

Results: Of the 68 responders 29 (43%) were gynecologists, 28 (41%) general surgeons, 7 (10%)gastroenterologists, and 4 (6%) subspecialty surgeons. 81% were from the US. 27 (40%) responders had performed at least 20 colpotomies and 22 (33%) had not performed a colpotomy before. 33% considered the procedure very safe, 49% safe, and 18% somewhat safe. 39% of those who had performed colpotomies before reported having experienced technique-related complications (i.e. bleeding, bowel or bladder injury) most of them minor. The reported learning curve was 1-5 cases for 26% of responders, 6-10 cases for 35%, 11-20 cases for 21%, and >21 cases for 18%. Survey participants felt that at least 5-10 colpotomies should be performed under supervision (ideally by an experienced gynecologist) before individual practice should be allowed. They also identified didactic lectures on anatomy, technique indications, and complications, practice on appropriate simulators, team training, and performance of proctored cases in the operating room as essential elements of training requirements for colpotomy.

Conclusions: Based on the results of this survey the first 5-10 colpotomy procedures by surgeons unfamiliar with the technique should be performed under the supervision of an experienced gynecologist to minimize adverse outcomes. In addition, respondents agreed that prior to practice in the operating room, surgeons should have dedicated didactic lectures on the technique and hands-on practice. The proposed criteria should be implemented in actual practice for validation.

Session: Poster Presentation

Program Number: P192

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