The Current State of AAGL-Fellowship in Minimally Invasive Gynecologic Surgery: Surgical Volume and Case Types

STUDY OBJECTIVE: To describe the current state of the American Association of Gynecologic Laparoscopists (AAGL)-Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) programs, assessing case volume, case types, and differences among programs. DESIGN: Retrospective cohort study. SETTING: FMIGS in the United States. PATIENTS: All fellows who started and completed an AAGL-FMIGS program in the United States between 2020 and 2024. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: During the study period, 130 fellows completed a 2 or 3-year fellowship from start to finish among 52 fellowships. The median number of total cases completed in a 2-year fellowship was 510 (interquartile range [IQR], 428-586). The most common procedure was hysterectomy (median, 210 [IQR, 174-255]), followed by peritoneal procedures, which included retroperitoneal dissection and adhesiolysis (median, 125 [IQR 91-167]), and endometriosis procedures (median, 89 [IQR, 56-132]). The medians for other case types were as follows: myomectomies (including hysteroscopic), 62 (IQR, 40-95); adnexal surgeries, 39 (IQR, 25-67); and hysteroscopies (excluding hysteroscopic myomectomy), 45 (IQR, 35-77). Among the 130 fellows, 67% (n = 87) had FMIGS-trained program directors and 33% (n = 43) had non-FMIGS-trained program directors. Fellows from programs with FMIGS-trained program directors had greater surgical volume than fellows with non-FMIGS-trained program directors (median number of cases per fellow, 537 [IQR, 468-620] vs 464 [IQR, 367-551]; p = .03). Furthermore, fellows from programs with FMIGS-trained program directors compared with those with non-FMIGS-trained program directors completed a median of 108 vs 58 endometriosis surgeries (p = .01), 71 vs 44 myomectomies (p = .01), 52 vs 39 hysteroscopies (p = .06), and 215 vs 187 hysterectomies (p = .27), respectively. CONCLUSION: Adopting the Accreditation Council for Graduate Medical Education case log system provided greater insight into the volume and types of cases completed in AAGL-FMIGS programs. Overall, AAGL-FMIGS programs have robust surgical volume with program director training affecting volume and case types. Fellows from programs with FMIGS-trained program directors have significantly greater total case volume, myomectomies, and endometriosis surgeries.