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To study if separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection (SSI) rates. A retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery (MIGS) subspecialists from 1/2016 through 5/2023. Conventional TLHs. A total of 680 patients, of which 377 (55.4%) underwent TLH by Surgeon 1 and 303 (44.6%) by Surgeon 2. Preoperative antibiotic prophylaxis was administered per formal guidelines. All patients underwent perineal-vaginal preparation and separate abdominal preparation. Surgeon 1 performed surgeries with surgical field separation, which included glove changes of the top gloves when crossing fields, while Surgeon 2 performed surgeries without changes. The two surgeons had access to the same operating rooms, staff, trainees, anesthesiology group and instruments sterilization process. Data was collected from the electronic medical record. We assessed characteristics and outcomes of patients who underwent TLH with Surgeon 1 and Surgeon 2. The primary outcome was the occurrence of any postoperative infection within 30 days of surgery. The overall SSI rate was 1.0%. The occurrence of any infection was 0.8% (3/377) for Surgeon 1 vs. 1.3% [4/303, OR 95% CI 0.60 (0.13-2.70)] for Surgeon 2, including superficial incisional, deep incisional, organ/space, and urinary tract infections. All patients who had SSIs also received antibiotic prophylaxis during surgery. The occurrence of readmission, reoperation or vaginal cuff dehiscence was also low in both groups. The infection rate after TLH is low with or without surgical field separation, and our overall infection rate fell on the lower end of the reported range. Additional information on the need for surgical field separation is important because most emissions created by the healthcare system come from single-use items in the supply chain. [ABSTRACT FROM AUTHOR]

To evaluate patient satisfaction with in-person versus virtual visits among minimally invasive gynecologic surgery (MIGS) patients. Retrospective cohort study comparing satisfaction scores of patients who had virtual visits versus in-person visits. An urban quaternary care center from 4/2015-7/2023. We included patients who had the same type of visit, either virtual or in-office, before and after surgery, and responded to the surveys on both time points. Eight patient satisfaction questions were analyzed to assess satisfaction with the visit, provider, and office staff. The study included 349 patients, 262 in the virtual group and 87 in the in-person group. Patients who had virtual visits were younger (37.2 vs. 42.2 years, p<0.003) and less likely to be smokers (1.8% vs 8.0%, p<0.001). Patients who underwent hysteroscopy (4.2% vs. 16.1%, p<0.001) or robotic surgery (1.5% vs. 10.3%, p<0.001) were more likely to be seen in the office, while patients who underwent laparoscopic hysterectomy (21.8% vs. 33.3%, p=0.004) or endometriosis excision (20.2% vs. 18.4%, p<0.001) were more likely to be seen virtually. There was no difference in total hospital admission length. Patient satisfaction surveys for patients seen virtually had significantly higher overall scores for the facility (9.46 vs. 8.94, p<0.001), they were more likely to recommend the practice to their friends and family (9.56 vs 8.88, p<0.001), and felt more that staff did everything possible to help with their discomfort (3.69 vs 3.44, p<0.001). There was no significant difference noted for all other survey questions. We found that compared to patients who had in-person visits, those who had virtual visits before and after gynecologic surgery reported higher satisfaction scores when asked about the medical facility and the medical staff, while other satisfaction scores were comparable. [ABSTRACT FROM AUTHOR]