Obstetrics and Gynecology 2019 Projects

Project Title: A Comparison of Narcotic Use and Additional Post-Operative Factors Between Robotic Assisted Surgery and Laparoscopic Surgery in a Single General Surgeon’s Patient Base

Faculty Mentor’s Name: Dr. Patrick Duff
Email: duffp@ufl.edu

Student’s Name: Nicklas Sarantos
Email: nicklas01@ufl.edu

Project Description:

Robotic Assisted Surgery (RAS), a form of minimally invasive surgery, is a growing surgical field in which robotic instruments that mimic the surgeon’s hand movements are inserted into a patient’s body through multiple small incisions. RAS has been used most frequently in urological and obstetric surgeries, although data regarding its various advantages and postoperative effects has been ultimately conflicting (1,2,7,8). In one meta-analysis, RAS in specific urological procedures has been associated with various advantageous treatment effects, such as lower post-operative narcotic use, less perioperative complications, less estimated blood loss, lower need for transfusions, and lower overall length of post-operative hospital stay (1). In some obstetric procedures, such as hysterectomy for endometrial cancer, RAS has shown no difference in post-surgical narcotic use or perioperative outcomes when compared with traditional laparoscopic surgery (2). Although a variety of data has been collected with regards to urological and obstetric surgery, not much data has yet been collected regarding the outcomes of RAS compared with laparoscopy in general surgery.

The past three decades have shown increasing national rates of abuse of opioid analgesics, with a large number of these opioids being obtained through physician written prescriptions (3). Data has also shown a significant relationship between the ease of availability of these prescription drugs and the subsequent abuse of opioids, as well as a host of other adverse outcomes (3). In the first three months after surgery, 69% of opioid prescriptions were prescribed by surgeons, although this number drops to 20% after six months (5). Furthermore, of all previously non-opioid using patients undergoing both minor and major surgeries, 6% displayed new persistent opioid use 90 days after the procedure (6). General surgery in particular is associated with a wide variability in the amount of opioids prescribed to patients post-operatively, which can possibly be attributed to the wide variety of performed surgical procedures (4). Altogether, any surgical procedure that will allow surgeons to prescribe smaller amounts of opioids to patients can be beneficial in reducing the amount of opioid overprescription, as well as reducing long term rates of dependence on opioids in patients themselves.

Our aim is to retrospectively assess a variety of postsurgical and perisurgical outcomes when comparing robotic assisted surgery and traditional laparoscopic surgery in a single general surgeon’s patients. The primary focus will be on post-surgical narcotic and opioid use when compared between the different surgical modalities. However, due to the retrospective nature of the study, and the abundance of data available, we also expect to examine a variety of secondary effects, which may include (but are not limited to) blood loss, rates of transfusion, length of post-operative hospital stay, general post-operative complications, operative time, and cost.

Project Title: A retrospective Chart Review: The effects of marijuana use in utero and the achievement of early childhood developmental milestones

Faculty Mentor’s Name: Dr. Dikea Roussos-Ross
Email: kroussos@ufl.edu

Student’s Name: Victoria Dukharan
Email: vdukharan1@ufl.edu

Project Description:

The effects of marijuana exposure in pregnancy on childhood development are currently unknown. This project seeks to shed light on this relationship and inform mothers and healthcare professionals. Through analysis of maternal cases of marijuana use, children can be monitored to identify if they met developmental milestones and/or have psychosocial impairment.

Project Tile: Determining the Optimal Mode of Delivery in Patients with Hepatitis C: A Systematic Review

Faculty Mentor’s Name: Dr. Patrick Duff
Email: duffp@ufl.edu

Student’s Name: Morgan Brazel
Email: brazemor@gmail.com

Project Description:

Approximately 1-8% of pregnant women are infected with hepatitis C virus (HCV) across the world. (1) Of those pregnant women infected with HCV, there is around a 6% chance for mother-to-child transmission. The risk of vertical transmission increases to about 11% if the mother is co-infected with HIV. (2) Vertical transmission is the primary way children become infected with HCV. (3)

There are several known risk factors that increase the likelihood of transmission from mother to child, including HIV co-infection. (4) However, the effect that mode of delivery has on vertical transmission rates is still debated. For example, a study by Gibb et al. used 441 HCV-infected mothers and their infants to evaluate risk factors for vertical transmission of HCV and found that elective cesarean delivery was associated with a significantly lower transmission rate. None of the 31 children born via elective cesarean developed an HCV infection, while the transmission rate was 7.7% for the children born via vaginal births and 5.9% for children born via emergency cesarean (p=0.04). (5)

In contrast, a study by the European Paediatric Hepatitis C Virus Network, which includes 1479 HCV-infected mothers and their infants, found that there was not a significant difference in the vertical transmission rate depending on mode of delivery. The transmission rate of HCV for children born via elective cesarean was 7.3%, and it was 5.4% for children born via vaginal delivery or emergency cesarean (p=.16). (6) The goal of this systematic review is to determine if mode of delivery has an effect on the perinatal transmission of HCV infection. Specifically, we will try to determine if elective cesarean delivery before the onset of labor reduces the rate of mother-to-child transmission of HCV.

  1. Spera AM, Eldin TK, Tosone G, Orlando R. Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women? World J Hepatol. 2016;8(12):557–565. doi:10.4254/wjh.v8.i12.557
  2. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis. 2014;59(6):765–773. doi:10.1093/cid/ciu447
  3. Chehreh ME, Tabatabaei SV, Khazanehdari S, Alavian SM. Effect of cesarean section on the risk of perinatal transmission of hepatitis C virus from HCV-RNA /HIV− mothers: A meta-analysis. Archives of Gynecology and Obstetrics. 2010;283(2), 255-260. doi:10.1007/s00404-010-1588-9
  4. Mast EE, Hwang L, Seto DS, Nolte FS, Nainan OV, Wurtzel H, Alter MJ. Risk Factors for Perinatal Transmission of Hepatitis C Virus (HCV) and the Natural History of HCV Infection Acquired in Infancy. The Journal of Infectious Diseases. 2005;192(11):1880-1889. doi:10.1086/497701
  5. Gibb DM, Goodall RL, Dunn DT, Healy M, Neave P, Cafferkey M, Butler K. Mother-to-child transmission of hepatitis C virus: Evidence for preventable peripartum transmission. The Lancet. 2000;356(9233):904-907. doi:10.1016/s0140-6736(00)02681-7
  6. European Paediatric Hepatitis C Virus Network. A Significant Sex—but Not Elective Cesarean Section—Effect on Mother-to-Child Transmission of Hepatitis C Virus Infection. The Journal of Infectious Diseases. 2005;192(11):1872–1879. https://doi.org/10.1086/497695
  7. Society for Maternal-Fetal Medicine (SMFM), Hughes BL, Page CM, Kuller JA. Hepatitis C in pregnancy: screening, treatment, and management. American Journal of Obstetrics and Gynecology. 2017;217(5):B2-B12. https://doi.org/10.1016/j.ajog.2017.07.039

Project Title: Evaluation of gynecological oncologic outocmes in the elderly and super-elderly population

Faculty Mentor’s Name: Dr. Joel Cardenas MD
Phone: 352-273-7580
Email: joelcardenas@ufl.edu

Student’s Name: Sarah Kennedy
Email: gatorseh@ufl.edu

Project Description:

In 2018, there were an estimated 110,070 women diagnosed with a gynecological malignancy, and an estimated 32,120 deaths (Siegel 2018). The treatment of gynecological malignancies typically involves surgical or medical intervention, or both. Increasing age has long been associated with an increasing chance of diagnosis of malignancy. Patients with an advanced chronological age often have additional medical comorbidities that complicate medical and/or surgical intervention.

While many studies have shown that age is often associated with a poor prognosis, a large cohort study has failed to demonstrate age alone to be an independent prognostic factor (Jorgensen 2012). The aim of our study is to evaluate and compare the gynecological oncologic outcomes of elderly (70–80 years of age) and super-elderly (>80 years of age) patients receiving surgical intervention at UF Health.

Medical students can expect to be involved with the data review and collection efforts of this retrospective chart review study. This project is not funded by any agencies in the public, commercial, or not-for-profit sectors.

References:

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7-30.

Jorgensen TL, Teiblum S, Paludan M, et al. Significance of age and comorbidity on treatment modality, treatment adherence, and prognosis in elderly ovarian cancer patients. Gynecol Oncol. 2012;127:367-374.

Project Title: Outcomes following native tissue vaginal suspension for pelvic organ prolapse

Faculty Mentor’s Name: Dr. Emily Weber LeBrun
Phone: 352-318-4888
Email: eweber@ufl.edu

Student’s Name: Rania Saboungi
Email: raniasaboungi@ufl.edu

Project Description:

This is a descriptive study, there is no intervention planned, thus no mathematic hypothesis is given. The primary aim of this study is to determine surgical outcomes for patients undergoing Female Pelvic Medicine & Reconstructive Surgery (FPMRS), specifically native tissue reconstruction involving vaginal suspension (without mesh). The secondary aim is to identify complications and other post-operative events such as new-onset urinary symptoms. While this information may provide valuable benefit to advance the science of FPMRS, it is considered critical for a surgeon’s efforts toward career-long self-improvement.

The specific aims of the proposed project are:

  • Determine the post-operative outcomes (success) following vaginal suspension.
  • Identify post-operative events such as urinary incontinence or re-operation in this population

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