title: Gynecologic Oncologist as surgical consultant: intraoperative consultations during general gynecologic surgery as an important focus of gynecologic oncology training.
abstract: OBJECTIVE
  The aim of this study is to explore the previously unexamined role of the Gynecologic Oncologist as an intraoperative consultant during general gynecologic surgery.
  
  
  METHODS
  Demographic and clinical data were collected on 98 major gynecologic surgeries that included both a general Gynecologist and a Gynecologic Oncologist between October 2010 and August 2014. Data were analyzed using XLSTAT-Prov2014.2.02.
  
  
  RESULTS
  Of 794 major gynecologic surgeries, 98 (12.3%) cases that involved an intraoperative consultation were identified. There were 36 (37%) planned consults and 62 (63%) unplanned consults. Significantly more planned consults were during laparoscopy (100% v 58%; p<0.01) and significantly more unplanned consults were during laparotomy (42% v 0%; p<0.01). The majority of planned consults were for surgical training (86%) and the most common reasons for unplanned consults were adhesions (40%), bowel injury (19%), inability to identify ureter (19%), and cancer (11%). The most common interventions performed during unplanned consults were identification of anatomy (55%), lysis of adhesions (42%), and retroperitoneal dissection (27%). Average surgeon years in practice were significantly lower for unplanned consults (9 v 15; p<0.01). A total of 25 major adverse events occurred in 15 cases with the majority occurring in cases with unplanned consults (23% v 3%; p<0.01). After controlling for laparotomy, unplanned consultation was not significantly associated with major events (OR=6.67, 95%CI 0.69-64.39; p=0.10).
  
  
  CONCLUSIONS
  Gynecologic Oncologists play a pivotal role in the support of generalist colleagues during pelvic surgery. In this series, Gynecologic Oncologists were consulted frequently for complex major benign surgeries. It is important to incorporate the skills required of an intraoperative consultant into Gynecologic Oncology fellowship training.
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Department of Obstetrics and Gynecology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States. Electronic address: eaviki@partners.org.
authors.forename: Emeline M
authors.initials: EM
authors.lastname: Aviki
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: Tracilyn R
authors.initials: TR
authors.lastname: Hall
authors.affiliation: Department of Obstetrics and Gynecology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: Lori R
authors.initials: LR
authors.lastname: Berkowitz
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States.
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medicine School, Boston, MA, United States. Electronic address: agoodman@partners.org.
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006176:Gynecology / Q000193:education / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008495:Medical Oncology / Q000193:education / Q000379:methods*; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Benign Surgery; Fellowship training; Gynecologic Oncologist; Intraoperative Consultation; Surgical Complications