Design: This is a retrospective analysis of Medicare claims data for 2012- 2014. Patients undergoing open or Minimally Invasive Surgery (MIS) hysterectomy were identified by ICD-9 and CPT codes. Descriptive analytics were performed to identify the proportion of hysterectomies performed in an outpatient setting. Statistical significance was defined by p-value \= 0.05. Setting: N/A Patients: A total of 55,562, 53,460 and 53,049 patients were included in the analysis for 2012, 2013 and 2014, respectively. Intervention: N/A Measurements and Main Results: In 2014, 2,864 hospitals performed hysterectomies on Medicare patients. 2,367 hospitals performed 30 or fewer procedures in 2014. The top 20% (high volume) and bottom 20% (low volume) of hospitals by volume of hysterectomies were analyzed. In 2014, the 573 high volume hospitals performed 36,093 hysterectomies with 16,828 (47.1%) in the outpatient setting. The 573 low volume hospitals performed 770 hysterectomies with 136 (16.0%) in the outpatient setting (p \.0001). At the high volume hospitals, from 2012-2014, the outpatient procedure (OP) rate increased from 29.4% to 47.1% (p \.0001). The Northeast (20.6% to 40%, p \.0001) and the West (21.4% to 42.4%, p \.0001) had the lowest OP rates though the rate increased during those years. In the Midwest and the South, the OP rate increased from 27.3% to 48.8% (p \.0001) and 37.2% to 51.9% (p \.0001), respectively. At low volume hospitals, the OP rate increased from 8.9% to 16% from 2012-2014 (p=.0001). Conclusion: Higher volume of hysterectomy procedures is associated with a higher likelihood of procedures being performed in an outpatient setting. While there is regional variation in the OP rate at high volume hospitals, both high volume and low hospitals have experienced growth in OP rate for hysterectomies. 118 Open Communications 8 - Laparoscopic Surgeries (2:15 PM - 3:15 PM) 3:08 PM – GROUP B Laser Angiography with Indocyanine Green (ICG) to Assess Vaginal Cuff Perfusion During Total Laparoscopic Hysterectomy (TLH): A Pilot Study Beran BD, 1 Shockley ME, 1 Arnolds KD, 1 Escobar PF, 2 Zimberg SE, 1 Sprague ML. 1 1 Section of Minimally Invasive Gynecology, Cleveland Clinic Florida, Weston, Florida; 2 Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas Study Objective: To determine feasibility of using NIR perfusion angiography to assess vaginal cuff vascular perfusion during total laparoscopic hysterectomies. Design: Pilot experimental study. Setting: Academic-affiliated hospital. Patients: Twenty women undergoing TLH for benign disease. Intervention: Following intravenous administration of indocyanine green (ICG), NIR perfusion angiography was employed to capture images of the vaginal cuff before and after closure. Three reviewers analyzed NIR images of vaginal cuffs to determine percent of cuff perimeter with adequate perfusion when open and length of vaginal cuff adequately perfused when closed. Participants underwent 1:1 randomization of energy method used for colpotomy (ultrasonic versus monopolar) and vaginal cuff closure suture (barbed versus non-barbed). Measurements and Main Results: ICG was visible at the vaginal cuff in all participants. Mean time to appearance of ICG in the pelvis after administration was 19.78Æ6.75 seconds (meanÆS.D.) pre-closure, and 25.99Æ22.22 seconds post-closure. With ultrasonic energy, 67.47Æ17.42% (meanÆS.D.) of open cuff perimeter, and 74.42Æ20.5% of closed cuff length were adequately perfused, while with monopolar energy use, 59.14Æ17.43% of the open cuff perimeter and 66.28Æ15.4% of closed cuff length were adequately perfused. Cuffs closed with barbed suture showed adequate perfusion along 71.46Æ15.14% of the length, while those closed with non-barbed suture showed 68.94Æ20.94% adequate perfusion. When standardized to cervical cup circumference, ultrasonic energy required 0.97Æ0.21 s/mm (meanÆS.D.), while monopolar energy required 0.80Æ0.31 s/mm (p=0.162). Linear regression showed no association of standardized time of energy activation versus percentage of perimeter of open cuff (R2=0.007) or length of closed cuff (R2=0.005) with adequate perfusion. No complications related to intravenous ICG administration occurred. Conclusion: Intravenous ICG administration and use of NIR perfusion angiography allow evaluation of vascular perfusion at the vaginal cuff during TLH. This technique may inform future prospective studies examining causes for vaginal cuff dehiscence, which is most common following total laparoscopic hysterectomy. 119 Open Communications 9 - Basic Science/Research/ Education (2:15 PM - 3:15 PM) 2:15 PM – GROUP A Assessment of Reliability Between Live versus Recorded Evaluation of Cystoscopic Skills McKinney SA, Li J, King LP, Lefevre R, Haviland MJ, Hur H-C. Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Study Objective: To determine if there is a difference between unblinded live observation versus recorded assessment of cystoscopic skills using validated cystoscopy OSATS and GRS checklists. Design: Prospective cohort study. Setting: Academic tertiary care medical center. Patients: All Ob/Gyn residents from Beth Israel Deaconess Medical Center were invited to participate. Intervention: Ob/Gyn residents underwent a cystoscopy workshop with a didactic lecture and simulation skills component that used a wet-bladder model. Residents were videotaped during the simulation skills component. A 2-part validated cystoscopy assessment tool that includes an Objective Structured Assessment of Technical Skills (OSATS) checklist and Global Rating Scale (GRS) checklist was used to assess resident cystoscopy skills unblinded during their live performance. Residents were scored again with the same assessment tool in a blinded fashion using the recordings. Measurements and Main Results: A total of 19 (82.6%) Ob/Gyn residents participated in the workshop. Half (47.4%) of participants had performed >31 cystoscopies prior to the workshop. The median (interquartile range) OSATS score from live observation was 43.0 (39.0-46.0) and from recorded assessment was 43.0 (38.0-45.0). Median scores on the GRS were 24.0 (20.0-28.0) from live observation and 25 (19.0-27.0) from recordings. Spearman correlation coefficients were calculated to compare scores from live observation and recordings. Live and recorded scores were perfectly correlated with respect to the overall pass threshold (r=1.0, p \0.0001). There was also a statistically significant correlation between live and recorded scores for the OSATS (r=0.54, p=0.02) and GRS (r=0.69, p=0.001) checklists. The correlation was stronger for GRS scores than OSATS scores. Conclusion: There was perfect correlation for passing rates between direct observation and recorded assessment of cystoscopic skills using the OSATS and GRS assessment tools. Therefore, recorded assessment using OSATS and GRS checklists may offer an alternative option for objective blinded evaluation of cystoscopy skills without requiring live observation. 120 Open Communications 9 - Basic Science/Research/ Education (2:15 PM - 3:15 PM) 2:22 PM – GROUP A A Quantitative System for Technical Assessment and Training of Skills (STATS) for Surgical Performance Srinivasan S, 1 Krovi V, 2 Singhal P, 1 Misra S. 3 1 Department of Minimally Invasive Gynecology, Millard Fillmore Suburban Hospital, Williamsville, New York; 2 Department of Mechanical & Aerospace Engineering, State University of New York at Buffalo, Buffalo, New York; 3 Department of S49 Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252