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STUDY OBJECTIVE Learning to evaluate and treat chronic pelvic pain (CPP) is an established curriculum objective within the Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Our aim was to investigate current educational experiences related to the evaluation and management of CPP and the impacts of those experiences on FMIGS fellows and recent fellowship graduates, including satisfaction, confidence in management, and clinical interest in CPP. DESIGN The AAGL-Elevating Gynecologic Surgery Special Interest Group for pelvic pain developed a 33-item survey tool to investigate the following topics: (1) current educational experiences with the assessment and management of patients with CPP, (2) satisfaction with fellowship training in CPP, (3) perceived preparedness to treat patients with CPP, (4) plans to incorporate management of CPP into clinical practice, and (5) perceived desires to expand CPP exposure. Composite scores were created to examine experiences related to diseases associated with CPP and pharmaceutical and procedural treatment options. SETTING Electronic survey. PATIENTS Not applicable. INTERVENTIONS The survey was distributed via AAGL email lists and offered on FMIGS social media sites from August 2017 to November 2017 to all active FMIGS fellows and individuals who graduated the fellowship during the preceding 5 years. MEASUREMENTS AND MAIN RESULTS Fifty-three of 82 (65%) current FMIGS fellows and 104 of 169 (62%) recent fellowship graduates completed the survey. Only 66% of current fellows endorsed working with a fellowship faculty member whose clinical work focused on CPP. Most current fellows reported having a "good amount" of experience or "extensive" experience with superficial endometriosis (39/53, 74%) and deeply infiltrative endometriosis (34/53, 64%), whereas the majority reported having "no" or "little" experience with frequently comorbid conditions like irritable bowel syndrome (68%), pelvic floor tension myalgia (55%), and interstitial cystitis/painful bladder syndrome (51%). For both current fellows and recent graduates, increased CPP Disease Experience composite scores were associated with satisfaction with CPP training (current fellows odds ratio [OR] 1.9, p =.002; recent graduates OR 1.5, p < .001), perceived preparedness to treat patients with CPP (current fellows OR 2.0, p = .0021; recent graduates OR 1.5, p

Study Objective To present updated information regarding compensation patterns for Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS)–graduated physicians in the United States beginning practice during the last 10 years, focusing on the variables that have an impact on differences in salary, including gender, fellowship duration, geographic region, practice setting, and practice mix. Design An online survey was sent to FMIGS graduates between March 15, 2019 and April 12, 2019. Information on physicians’ demographics, compensation (on the basis of location, practice model, productivity benchmarks, academic rank, and years in practice), and attitudes toward fairness in compensation was collected. Setting Online survey. Participants FMIGS graduates practicing in the United States. Intervention E-mail survey. Measurements and Main Results We surveyed 298 US FMIGS surgeons who had graduated during the last 10 years (2009–2018). The response rate was 48.7%. Most of the respondents were women (69%). Most of the graduates (84.8%) completed 2- or 3-year fellowship programs. After adjustment for inflation, the median starting salary for the first postfellowship job was $252 074 ($223 986–$279 983) (Table 1). The median time spent in the first job was 2.6 years, and the median total salary at the current year rose to $278 379.4 ($241 437–$350 976). The median salary for respondents entering a second postfellowship job started at $280 945 ($261 409–$329 603). Significantly lower compensation was reported for female FMIGS graduates in their initial postfellowship jobs and was consistently lower than for that of men over time. Most FMIGS graduates (59.7%) reported feeling inadequately compensated for their level of specialization. Conclusion A trend toward higher self-reported salaries is noted for FMIGS graduates in recent years, with significant differences in compensation between men and women. Among obstetrics and gynecology subspecialists, FMIGS graduates earn significantly less than other fellowship-trained physicians, with median salaries that are lower than those of generalist obstetrics and gynecology physicians.

Study Objective The objective of this video is to review relevant surgical anatomy, resection and ablation methods, and techniques to optimize management of diaphragmatic endometriosis. Design Video footage of surgical anatomy and surgical technique. Institutional review board approval was not required. Setting Thoracic endometriosis lesions can involve the pleura, the lung, and the diaphragm. The prevalence of thoracic endometriosis is unknown, but most cases involve the diaphragm. A large percentage of patients are asymptomatic. Those who are symptomatic can present with cyclic shoulder pain, right upper quadrant pain, or catamenial pneumothorax. Symptomatic cases refractory to medical management or recurrence require surgical management [ 1 , 2 ]. Safe and efficient management of these cases depends on an experienced multidisciplinary team. In this video, the experiences and management tools used by our team are described. Interventions Laparoscopic management of primary and recurrent symptomatic diaphragmatic endometriosis. (1) The surgeon performing these procedures must be familiar with liver, diaphragmatic, and thoracic anatomy. (2) Preoperative magnetic resonance imaging should be used to map suspicious lesions. (3) Bronchoscopy should be available for double-lumen endobronchial tube placement for selective ventilation. (4) The operating room should have video-assisted thoracoscopy capability, and a thoracic surgeon should be available. (5) Intercostal nerve block with liposomal bupivacaine can be useful for postoperative pain control [ 3 , 4 ]. Conclusion A multidisciplinary skilled team approach to the surgical management of diaphragmatic endometriosis to optimize outcomes is preferred.

Essure hysteroscopic sterilization has been US Food and Drug Administration-approved in the United States since 2002. Complications associated with the Essure device include improper placement (malpositioning), unintended pregnancy, pain, infection, and nickel allergy. The rarity of complications, compounded by underreporting, makes it difficult to determine best practices insofar as management. This systematic review synthesizes the national and global experience with management of Essure-related complications and suggests treatment options when data allow.

Study Objective The Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) is a postresidency fellowship developed with the mission to train the next generation of minimally invasive gynecologic surgeons. The need for surgeons trained in this field has increased, yet there remains a paucity of information regarding the compensation of these specialized surgeons. Design A survey was sent via e-mail to FMIGS graduates (N = 221) using an online survey tool; it was sent twice more to increase the response rate between July and December 2013. The survey collected information on current and starting salaries and benefits as well as academic rank, location, practice type, and practice breadth. Comparisons were analyzed using multivariable linear regression models (Canadian Task Force Classification II-2). Setting E-mail–based survey. Patients Graduates of the FMIGS. Interventions A single survey sent 3 times. Measurements and Main Results Of 221 graduates surveyed, 164 responded (response rate = 74%). Sixty-one percent of respondents (n = 100) were from academic institutions, and the remainder were from private practice (n = 64). Of all respondents, 27 (16.5%) reported less than 1 year of postfellowship experience and had a median starting salary of $216 399 (range, $106 834–$542 930). Survey respondents were on average 3.3 years (range, 0–14) out of fellowship with a median salary of $238 198 (range, $108 200–$993 765). Academic surgeons (average experience = 3.4 years) earned $208 743 (range, $106 834–$542 930) compared with private practice surgeons (average experience = 3.2 years) who earned $233 020 (range, $115 000–$454 448). Conclusion Salaries and compensation benefits of graduates of the FMIGS are varied. This information is very relevant to those attempting to hire or become employed as gynecologic surgical specialists.