Attendees were precepted in both suturing and knot tying, and to complete the ��Holiotomy challenge.�� (Figures (Figures11 and and2).2). A ��Holiotomy�� is the name used in the course for a 4cm segment of a penrose drain, attached by Velcro to the floor of the pelvic trainer box suture area. Six dots were placed on each side of a 2cm hole cut into new the top side. The challenge was to place three ��figure of N�� sutures, precisely through each of the dots, and then tie with at least four throws of a square knot, usually many more. Surgeons were asked to hand in at least two holiotomies, which meant that they had placed over 24 sutures through a small dot and tied over 24knots. The holiotomies were then attached by their Velcro base near the surgeons name on a prominently placed poster board to acknowledge the accomplishment and enhance esprit de corps (Figure 3).

The pelvic trainers were unassigned and available to all attendees at all other times during the course to enable as much practice time as they chose. Figure 1 Surgeons work with supervision to complete their Holiotomy challenges using laparoscopic simulator trainer boxes. Figure 2 (a) This ��Holiotomy�� is marked with dots on each side, which surgeons must suture through in placing three ��figure of N’s�� and then tie each with four square knots. Thus, twenty-four sutures are passed through a dot, and … Figure 3 The first Holiotomy board attested to completion of the Holiotomy challenge, and revealed participation and completion by 88% of the 225 attendees.

Finally, an optional 4-hour cadaver dissection session with four surgeons and one faculty to each specimen was available to 120 attendees. General gynecologic surgeons first performed TLH, then other advanced laparoscopic procedures such as ureterolysis, appendectomy, burch colposuspension, and uterosacral ligament colposuspension, while gynecologic oncologist attendees performed retroperitoneal aortic and pelvic lymphadenectomy and radical hysterectomy. This optional segment was accompanied by four lectures on challenging hysterectomies such as for the obese, the elderly, or those with adhesions or massive fibroids. 2.2. Data Management Data were entered into Excel, cleaned, and then uploaded into SPSS (Version 17) for analyses. Sample descriptive statistics were generated and more complex statistics were calculated based upon the research questions.

Because we had paired data, we were able to use statistics that are specific for this type of data including paired t-tests and McNemar’s Chi Squares. ANCOVAs were also performed [5]. Significance was preset at P < .05. 3. Results Of Carfilzomib the 216 participants in the course, 102 returned their second evaluation forms for a response rate of 47%. The typical participant was female (62%), did not complete a fellowship (90%), and had an average age of 44.7 years. There were no significant differences in age or gender in the responders versus the nonresponders.