Browsing by Subject "Gynecologic Surgical Procedures"
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Item Gynecologic surgery: call for reform(2021-05-11) King, Louise P.In this lecture, I describe historical and other influences that drive "double discrimination" in gynecologic surgery - lower pay in the area of surgery, which boasts the largest proportion of female surgeons, and potentially lower quality care for the field's exclusively female patients. Insurers reimburse procedures for women at a lower rate than similar procedures for men, although there is no medically justifiable reason for this disparity. The wage gap created by lower reimbursement rates disproportionately affects women surgeons who are disproportionately represented among gynecologic surgeons. This contributes to a large wage gap in surgery for women. Finally, poor reimbursement for gynecologic surgery pushes many Ob/Gyn surgeons to preferentially perform obstetric services resulting in a high prevalence of low-volume gynecologic surgeons, a metric that is closely tied to higher complications. Creating equity in reimbursement for gynecologic surgery is one important and ethical step forward to gender equity in medicine for patients and surgeons.Item High Midline Levator Myorrhaphy for Vaginal Vault Prolapse: Long-Term Results(2016-01-19) Wu, Yuefeng (Rose); Christie, Alana; Alhalabi, Feras; Zimmern, Philippe E.INTRODUCTION AND OBJECTIVE: To review long-term outcomes following a vaginal native tissue repair (High Midline Levator Myorrhaphy, HMLM) in women with symptomatic vault prolapse.1, 2 METHODS: Following IRB-approval, a prospectively maintained database of women who underwent HMLM for symptomatic vault prolapse (VP) alone or associated with other POP was reviewed for demographic data, history of prior POP, physical examination, hospital stay length, and long-term outcomes. Patients with <6 months follow up and no retrievable operative notes were excluded. Data was reviewed by a third party investigator not involved in patient care. Failure was defined as same compartment POP ≥ stage 2 or POP reoperation. Descriptive statistics and Kaplan-Meier curves were obtained. RESULTS: Between 1996 and 2014, 94 women who underwent HMLM were studied. Mean follow-up time was 7.7 (0.6-18.4) years, mean age was 69.6 (36-91), and 89% were Caucasian. Patients were grouped by POP indications: VP (6), vault and anterior (26), vault and posterior (35), and all 3 compartments (27) (Table 1). No intra-operative complications were reported. Ten (11%) early complications (<30 days) were noted (Clavien I/II). Sixty-seven (71%) women were cured of VP. Ten women (11%) had failure in a non-apical compartment and 17 (18%) had apical failure. Reoperation rate was 14% (13/94) and 5% (5/94) for vault and non-vault recurrences, respectively. VP recurrence-free probability between women with ≤ 2 versus 3 POP compartments was statistically significant (p = 0.0128). CONCLUSIONS: At a mean follow-up of 7-8 years, HMLM was successful in two thirds of women. Best outcome was noted in women with VP and one associated compartment prolapse. REFERENCES: 1. Lemack, G. E., et al. Urology, 56: 50, 2000. 2. Natale, F. et al. J Urol, 180: 2047, 2008Item An Instructional Video to Teach the Anatomy, Classification, and Repair of a Fourth-Degree Perineal Laceration(2007-12-18) Pietz, Jordan Taylor; Calver, Lewis E.The goal of this thesis project was to create an instructional video for first-year obstetrics and gynecology residents to instruct them on the anatomy and procedural steps involved in the layered repair of a fourth-degree laceration. The video combines a wide array of media including illustrations, animations, video, and stills to cover three key points: a general overview of female pelvic anatomy, a classification of procedural degrees of perineal lacerations and steps for the repair with emphasis on anatomy and surgical principles. This project would be used as a supplemental resource to the textbook and hands-on training. These current resources have been shown to be insufficient for proper comprehension of this information, resulting in improper care of patients.