Understanding the Collaboration Between MIGS and Urogynecology Specialists on Joint Operating Cases

INTRODUCTION: The conditions treated and procedures performed by minimally invasive gynecological surgeons (MIGs) and urogynecology surgeons are heavily intertwined. Patients with a history of hysterectomy are at increased risk of both pelvic organ prolapse, primarily of the posterior compartment, and stress urinary incontinence. MIGS and urogynecology procedures can be performed in the same surgical encounter. Patients who have preexisting POP or urinary incontinence may benefit greatly from collaborative efforts amongst MIGS and urogynecology specialists both in the outpatient and OR setting. OBJECTIVE: Combined surgical cases are safe and reduce anesthesia time and patient burden by decreasing the number of operating events, recovery time, and financial strain. Our objective is to evaluate the extent of collaboration between MIGs and urogynecologists in the operating room, identifying barriers and opportunities for improvement, given the benefit of opportunistic multidisciplinary care. METHODS: This is an IRB-approved cross-sectional survey study conducted by distributing a preliminary 15-question survey to MIGs and urogynecology faculty members, including fellows at 27 academic institutions and community programs with both MIGs and urogynecology fellowship programs from March to June of 2025. Based on preliminary responses, three additional questions were added to refine the quality of our survey, yielding a final 18-question survey. From July to September, an 18-question survey was distributed to Society of Gynecologic Surgeons (SGS) members through two reminder emails sent at a 2-month interval. Primary outcomes included the number of joint operating room (OR) cases in the past 12 months and frequency of collaboration. Responses were anonymous and descriptive statistical analysis was performed using REDCap. RESULTS: We analyzed 157 complete survey responses (Table 1). The majority of respondents were urogynecologists (65.6%), followed by MIGs specialists (27.4%), with most practicing in academic medical centers (82.2%) with varied experience levels. Most respondents practiced in the Northeast (39.5%) or Midwest (25.5%). Over the past 12 months, more than half (51.0%) participated in 1–5 joint operating cases, while 24.8% reported no cases and only 24.2% reported greater than 6 cases. Collaboration was most often described as occasional (42.0%) or sometimes (22.3%). MIGs providers most frequently partnered with urogynecologists for procedures addressing prolapse and stress urinary incontinence, while urogynecologists collaborated with MIGs colleagues on hysterectomy, myomectomy, and endometriosis excision. In shared cases, responsibility distribution most commonly involved the urogynecologist managing vaginal suspensions or sling placement, while MIGs specialists performed laparoscopic or abdominal components. The leading reason for collaboration was management of complex patient cases (∼80%), followed by patient referral (∼32%), skill advancement (∼29%), and institutional requirements (∼24%). The most frequently cited barriers were scheduling conflicts, resource limitations, and poor interspecialty communication (each ∼30–40%). Facilitators included improved scheduling (82.8%), institutional support (55.2%), and recognition of multidisciplinary value (55.2%). CONCLUSIONS: While collaboration between MIGS and urogynecologists is recognized as beneficial, it remains infrequent as OR case collaboration was minimal in a 12-month span. Enhancing scheduling efficiency, facilitating referrals, and introducing incentives for multidisciplinary care can foster greater cooperation. In the future, studies should focus on determining ideal candidates for joint surgical interventions and generating a referral system to facilitate joint collaboration.Table 1