Browsing by Subject "MIGS"

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    Needs Assessment of a Minimally Invasive Gynecologic Surgery (MIGS) Curriculum: Perspectives of Recent OB/GYN Graduates​
    (2025-04-25) Bode, Leah; Dadrat, Alexandra; Spielman, Sara; Picklesimer, MaKayla; Gnade, Colette; Oshinowo, Adeoti
    Introduction Current Accreditation Council for Graduate Medical Education (ACGME) guidelines for endoscopy and laparoscopy training are vague, and previous research indicates a significant proportion of graduating obstetrics and gynecology (OB/GYN) residents feel inadequately trained in minimally invasive gynecologic surgery (MIGS). Study Objective The study evaluates the experience of recent Indiana University School of Medicine (IUSM) OB/GYN residency graduates and assess the need for an enhanced MIGS curriculum. Methods This study surveyed 51 IUSM OB/GYN residency and fellowship graduates (2018-2022) using Likert-type items to assess satisfaction with the curriculum, confidence in robotic and laparoscopic skills, frequency of skills simulation, confidence performing various hysterectomy methods as lead surgeon, and current MIGS utilization in practice. Bivariate analysis, Pearson correlation, and thematic analysis of open-ended responses were performed. Results Twenty-eight graduates (55%) responded. While 80% expressed satisfaction with the overall quality of MIGS training, only 70% felt adequately prepared to perform laparoscopic hysterectomy and 28% felt prepared for robotic surgery post-graduation. A strong positive correlation (r=.63, p < .0001) existed between training in robotic operating room (OR) team dynamics and perceived preparedness for independent robotic surgery. Most trainees (74%) expressed interest in robotic certification if readily available. Key themes from open-ended responses included the importance of early robotics exposure and protected time for MIGS simulations. Conclusions These findings reveal that graduates under the current IUSM curriculum do not feel adequately prepared for laparoscopic and, especially, robotic surgery. The significant disparity between laparoscopic and robotic skill comfort highlights the need for a robust, standardized MIGS curriculum. We hypothesize this needs assessment and overlapping resident and fellow curriculum will provide the framework for an optimal MIGS curriculum, better equipping OB/GYN graduates for evolving gynecologic surgery
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    Valve-Like Outflow System Behavior With Motion Slowing in Glaucoma Eyes: Findings Using a Minimally Invasive Glaucoma Surgery–MIGS-Like Platform and Optical Coherence Tomography Imaging
    (Frontiers Media, 2022-04-29) Johnstone, Murray; Xin, Chen; Acott, Ted; Vranka, Janice; Wen, Joanne; Martin, Elizabeth; Wang, Ruikang K.; Ophthalmology, School of Medicine
    Purpose: This study aimed to investigate anatomic relationships and biomechanics of pressure-dependent trabecular meshwork and distal valve-like structure deformation in normal and glaucoma eyes using high-resolution optical coherence tomography (HR-OCT). Methods: We controlled Schlemm's canal (SC) pressure during imaging with HR-OCT in segments of three normal (NL) and five glaucomatous (GL) ex vivo eyes. The dissected limbal wedges were studied from 15 locations (5 NL and 10 GL). A minimally invasive glaucoma surgery (MIGS)-like cannula was inserted into the SC lumen, whereas the other end was attached to a switch between two reservoirs, one at 0, the other at 30 mm Hg. A steady-state pressure of 30 mm Hg was maintained to dilate SC and collector channels (CC) during 3D volume imaging. The resulting 3D lumen surface relationships were correlated with internal structural features using an image mask that excluded tissues surrounding SC and CC. While imaging with HR-OCT, real-time motion responses in SC and CC areas were captured by switching pressure from 0 to 30 or 30 to 0 mm Hg. NL vs. GL motion differences were compared. Results: Lumen surface and internal relationships were successfully imaged. We identified SC inlet and outlet valve-like structures. In NL and GL, the mean SC areas measured at the steady-state of 0 and 30 mm Hg were each significantly different (p < 0.0001). Synchronous changes in SC and CC lumen areas occurred in <200 ms. Measured SC area differences at the steady-state 0 and 30 mmHg, respectively, were larger in NL than GL eyes (p < 0.0001). The SC motion curves rose significantly more slowly in GL than NL (p < 0.001). Pressure waves traveled from the cannula end along the SC lumen to CC and deep intrascleral channels. Conclusion: HR-OCT provided simultaneous measurements of outflow pathway lumen surfaces, internal structures, and biomechanics of real-time pressure-dependent dimension changes. We identified SC inlet and outlet valve-like structures. GL tissues underwent less motion and responded more slowly than NL, consistent with increased tissue stiffness. A MIGS-like shunt to SC permitted pulse waves to travel distally along SC lumen and into CC.