Intermediate Level Laparoscopic Surgery

Transcription

1 SPECIAL SKILLS TRAINING MODULE Intermediate Level Laparoscopic Surgery APRIL 00 Royal College of Obstetricians and Gynaecologists in collaboration with the British Society for Gynaecological

2 Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists Registered Charity No Royal College of Obstetricians and Gynaecologists Further copies of this module can be obtained from: Postgraduate Training Department Royal College of Obstetricians and Gynaecologists Sussex Place Regent s Park London NW RG Telephone: + (0) 0 00 Facsimile: + (0) 0 0 website: Printed by Manor Press, Unit, Priors Way, Maidenhead, Berks. SL EL.

3 CONTENTS INTRODUCTION Entry criteria Training programme components The logbook (guide to learning) TRAINING DETAILS RECORD OF ATTENDANCE Operating Lists 9 Outpatient Clinics 0 Laboratory Sessions AUDIT GENERIC SKILLS ADHESIONS ECTOPIC PREGNANCY OVARY ENDOMETRIOSIS APPENDIX : CONTENTS OF THEORETICAL COURSE 9 REGISTRATION FORM REGISTRATION FORM FOR NON-TRAINING GRADES NOTIFICATION OF COMPLETION OF TRAINING MODULE Intermediate Level Laparoscopic Surgery Special Skills Training Module

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5 INTRODUCTION Competence in laparoscopic surgery arms the gynaecologist with a powerful diagnostic and therapeutic skill. The magnified endoscopic image and instrumentation provide advantages that have no equivalent in open surgery. This module will facilitate intermediate level laparoscopic capability with a concomitant knowledge base to allow its application in clinical practice. Once trained, an individual should be able to: Understand and apply principles of safe laparoscopic surgery correctly select patients suitable for laparoscopic procedures counsel and consent patients appropriately demonstrate knowledge of equipment, theatre set-up and instrumentation lead the surgical team be familiar with all important laparoscopic entry techniques avoid, recognise and understand the management of entry, intra- and postoperative complications and know when to refer understand and use energy sources safely. Entry criteria As special skills training should follow the completion of core training, the following criteria must be met:. The trainee must have passed Part MRCOG or hold an equivalent qualification.. The trainee must have satisfactorily completed the Core Logbook requirements.. The trainee must have obtained a satisfactory year three RITA.. The trainee must be a member of the British Society for Gynaecological Endoscopy (BSGE). Registration with the RCOG for special skills training can only be made when the above criteria are met. Specialist Registrars with fixed term training appointments (FTTA) who wish to register with the RCOG for special skills training should also fulfil the above criteria. Training programme components The following are essential components of the training programme, and all of them have to be completed.. Training must be undertaken under the supervision of an identified preceptor. The preceptor must be skilled in laparoscopic surgery and will supervise at least 0 theatre sessions in which the trainee will be primary surgeon for part of at least one operative procedure. The record of attendance should document all the cases which took place on each list which the trainee attended. In the event of the trainee failing to make adequate progress through the module, these lists will provide evidence of the availability of training opportunities. Intermediate Level Laparoscopic Surgery Special Skills Training Module

6 . The trainee should attend at least ten outpatient sessions under the supervision of the preceptor where focus is directed on patient selection, counselling and consent for laparoscopic procedures.. The trainee should attend regular laboratory sessions focused on exercises and techniques, as guided by their preceptor. Sessions should exceed 0 minutes and total not less than 0 hours.. The trainee will keep a record of attendance at lists, out patient clinics and lab sessions.. Trainees should complete a clinical audit on a subject related to the use of laparoscopic surgery in the management of gynaecological conditions. This should be completed to the preceptor s satisfaction.. The preceptor should undertake direct supervision of the trainee for the bulk of the module. On occasion, the trainee may undertake sessions under the supervision of professionals other than the preceptor. In these circumstances, it is the preceptor s duty to ensure that the professional to whom the duty of training is delegated is sufficiently competent, willing and able to teach the trainee. Dual preceptorship is also acceptable. Under these circumstances, at least one of the preceptors should hold the MRCOG, FRCOG or equivalent.. The preceptor must demonstrate a regular laparoscopic workload, containing at least one operating list per week at which laparoscopic surgery is performed. He or she must ensure the provision of camera systems, insufflation and instrumentation of appropriate quality to provide excellence in training. They must also ensure adequate dry laboratory facilities to allow the practice of laparoscopic skills within a risk-free environment. The preceptor should preferably be a member of the BSGE.. Trainees should obtain an application form for special skills training from the Postgraduate Training Department of the RCOG and ensure that it is completed. The special skills training plans of the trainee should be discussed at the year two RITA. During SpR year three, the trainee should obtain the chosen module and application forms from the RCOG Postgraduate Training Department, make contact with a preceptor in their chosen module, discuss rotations with the Deanery Specialist Training Committee (DSTC) and ensure that their application form is completed. At the Year three RITA assessment, the trainee should ask the Chairman of the DSTC to sign the application form in support of the module and send a copy of the completed form to the RCOG. 9. Trainees must attend a BSGE/RCOG approved theoretical course that should provide the essential knowledge component of training for this module. It is expected that trainees will also supplement their knowledge by reading standard textbooks and other literature. The theoretical course can be attended at any time after registration and the core knowledge gained will be assessed within the case reports submitted as part of the module. Training will be deemed to be complete when all the components have been completed to the satisfaction of the preceptor. The Completion of Training Certificate should be signed by the trainee, preceptor and Chairman of the Deanery Specialist Training Committee and sent to the Postgraduate Training Department at the RCOG. Special Skills Training Module Intermediate Level Laparoscopic Surgery

7 The logbook (guide to learning) This logbook defines the skills required for intermediate level laparoscopic surgery. Completion of the logbook will allow the preceptor and trainee to monitor progress and identify deficiencies over the course of training. It is important to note that the logbook is a record of competence rather than experience. The preceptor and trainee will review the progress of training every two months. Competence will be documented by the preceptor signing the appropriate sections of the logbook. The levels of competence are: Level Requires direct supervision. Level Competent to perform the exercise independently. It is imperative that all participants appreciate that the trainee s progress has to meet standards that satisfy the preceptor. At the end of the training programme, the preceptor has to certify that the skills attained by the trainee are to his or her satisfaction. Intermediate Level Laparoscopic Surgery Special Skills Training Module

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9 TRAINING DETAILS Trainee name: Address: National Training Number: Preceptor: Address: Date of commencement of training: Date of attendance at theoretical course: Date of completion of training: Intermediate Level Laparoscopic Surgery Special Skills Training Module 9

10 RECORD OF ATTENDANCE Operating Lists 0 Special Skills Training Module Intermediate Level Laparoscopic Surgery Date of list Procedure Role Preceptor s A, B, C, D* signature * Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer

11 RECORD OF ATTENDANCE Operating Lists Intermediate Level Laparoscopic Surgery Special Skills Training Module Date of list Procedure Role Preceptor s A, B, C, D* signature * Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer

12 RECORD OF ATTENDANCE Operating Lists Special Skills Training Module Intermediate Level Laparoscopic Surgery Date of list Procedure Role Preceptor s A, B, C, D* signature * Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer

19 RECORD OF ATTENDANCE Operating Lists Intermediate Level Laparoscopic Surgery Special Skills Training Module 9 Date of list Procedure Role Preceptor s A, B, C, D* signature * Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer

20 RECORD OF ATTENDANCE Operating Lists 0 Special Skills Training Module Intermediate Level Laparoscopic Surgery Date of list Procedure Role Preceptor s A, B, C, D* signature * Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer

22 RECORD OF ATTENDANCE Outpatient clinics At least ten clinics under supervision of the preceptor must be attended. Keep a record of relevant patients, seen with or discussed with your preceptor. Date Diagnosis/complaint Preceptor s signature Special Skills Training Module Intermediate Level Laparoscopic Surgery

23 RECORD OF ATTENDANCE Outpatient clinics At least ten clinics under supervision of the preceptor must be attended. Keep a record of relevant patients, seen with or discussed with your preceptor. Date Diagnosis/complaint Preceptor s signature Intermediate Level Laparoscopic Surgery Special Skills Training Module

24 RECORD OF ATTENDANCE Outpatient clinics At least ten clinics under supervision of the preceptor must be attended. Keep a record of relevant patients, seen with or discussed with your preceptor. Date Diagnosis/complaint Preceptor s signature Special Skills Training Module Intermediate Level Laparoscopic Surgery

25 RECORD OF ATTENDANCE Laboratory sessions A variety of exercises must be undertaken, including suturing and knot tying. Sessions can last a variable length of time but a total of 0 hours should be completed, spread over the duration of training. It is recommended that skills are maintained by laboratory practice at least once a month. Date Duration of session/exercise Preceptor s signature Intermediate Level Laparoscopic Surgery Special Skills Training Module

26 RECORD OF ATTENDANCE Laboratory sessions A variety of exercises must be undertaken, including suturing and knot tying. Sessions can last a variable length of time but a total of 0 hours should be completed, spread over the duration of training. It is recommended that skills are maintained by laboratory practice at least once a month. Date Duration of session/exercise Preceptor s signature Special Skills Training Module Intermediate Level Laparoscopic Surgery

27 AUDIT Audit Summary Date completed Preceptor s signature Intermediate Level Laparoscopic Surgery Special Skills Training Module

28 PAEDIATRIC & ADOLESCENT GYNAECOLOGY GENERIC SKILLS SKILL Level Level Equipment setup Theatre setup Patient position Select appropriate entry technique Closed entry Open entry Palmer s point entry Appropriate insufflation pressures Secondary port positions Optimisation of image Camera orientation Normal pelvic survey Identify ureters Tissue manipulation Blunt dissection Sharp dissection Appropriate haemostatic techniques Tissue retrieval Suturing Check for bowel integrity Check for bladder integrity Port closure Recognise intraoperative complications: Bowel injury Ureteric injury Haemorrhage Supervised Independent Preceptor s signature NB: If, during the training period, the trainee does not experience all of these complications, then the preceptor can sign off the competence if he or she is satisfied that the trainee has the ability to recognise and treat them appropriately. Special Skills Training Module Paediatric & Adolescent Gynaecology

29 ADHESIONS SKILL Level Level Patient selection Preoperative counselling Perform adhesiolysis Postoperative care Supervised Independent Preceptor s signature* ECTOPIC PREGNANCY SKILL Level Level Patient selection Preoperative counselling Perform salpingectomy Perform salpingotomy Postoperative care Supervised Independent Preceptor s signature* Intermediate Level Laparoscopic Surgery Special Skills Training Module 9

30 OVARY SKILL Level Level Patient selection Preoperative counselling Perform ovarian cystectomy Perform oophorectomy Postoperative care Supervised Independent Preceptor s signature* ENDOMETRIOSIS SKILL Level Level Patient selection Preoperative counselling Perform excision/ablation of peritoneal endometriosis Perform excision/ablation of endometrioma Postoperative care Supervised Independent Preceptor s signature* 0 Special Skills Training Module Paediatric & Adolescent Gynaecology

31 APPENDIX Contents of theoretical course Attendance at a theoretical course is mandatory and can be undertaken at any time after enrolment. The contents of the theoretical course should include at least the following, in addition to covering the subjects outlined in the syllabus above: history of laparoscopic surgery overview of laparoscopic surgery patient selection counselling equipment and theatre team electrosurgery other energy sources surgical training the role of the anaesthetist entry techniques adhesions ectopic pregnancy ovarian cysts endometriosis complications and how to deal with them documentation. Intermediate Level Laparoscopic Surgery Special Skills Training Module

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33 Royal College of Obstetricians and Gynaecologists SPECIAL SKILLS TRAINEE REGISTRATION FORM Please insert name of module: To be completed and returned to the: Special Skills Secretary, Postgraduate Training Department, RCOG, Sussex Place, Regent s Park, London NW RG. Please complete both sides of the form in block letters in black ink. TO BE COMPLETED BY TRAINEE SURNAME:... OTHER NAMES:... RCOG REG NO: (V)NTN: / / / MALE FEMALE ENTRY CRITERIA: (you must have possession of the MRCOG) Date obtained MRCOG: / / NAME AND ADDRESS OF TRAINING CENTRE: DATE OF COMMENCEMENT OF TRAINING: / / I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE: If you have attended please give date: / / Would you like to receive information on the approved theoretical course: YES NO Trainee s signature:...date:... Please complete overleaf

34 TO BE COMPLETED BY PRECEPTOR(S) Name of preceptor(s) in charge of training (please print name):. Name:.... Name:... Post:... Post:... Department address: Department address: I agree to provide the training necessary for the completion of this Special Skills Module. Preceptor signature (): Preceptor signature (): Date:... Date:... TO BE COMPLETED BY THE RCOG COLLEGE TUTOR I confirm that the trainee can undertake this module of Special Skills Training under the supervision of the preceptor(s) listed above. Please print name:... Signature:... Date:... TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALIST TRAINING COMMITTEE I confirm that the trainee has completed core training and that the Deanery Specialist Training Committee has approved the training module for the trainee, preceptor(s) and programme of training. Please print name:... Signature:... Date:... IT IS THE RESPONSIBILITY OF THE TRAINEE TO OBTAIN THE REQUIRED SIGNATURES FOR THIS FORM BEFORE FORWARDING TO THE COLLEGE

35 Royal College of Obstetricians and Gynaecologists SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES Please insert name of module: To be completed and returned to the: Special Skills Secretary, Postgraduate Training Department, RCOG, Sussex Place, Regent s Park, London NW RG. Please complete both sides of the form in block letters in black ink. TO BE COMPLETED BY DOCTOR SURNAME:... OTHER NAMES:... RCOG REG NO:... MALE FEMALE ENTRY CRITERIA: (you must have possession of the MRCOG) Date obtained MRCOG: / / NAME AND ADDRESS OF TRAINING CENTRE: DATE OF COMMENCEMENT OF TRAINING: / / I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE: If you have attended please give date: / / Would you like to receive information on the approved theoretical course: YES NO Doctor s signature:...date:... Please complete overleaf

36 TO BE COMPLETED BY PRECEPTOR(S) Name of preceptor(s) in charge of training (please print name):. Name:.... Name:... Post:... Post:... Department address: Department address: I agree to provide the training necessary for the completion of this Special Skills Module. Preceptor signature (): Preceptor signature (): Date:... Date:... TO BE COMPLETED BY THE CLINICAL DIRECTOR I confirm that the doctor can undertake this module of Special Skills Training under the supervision of the preceptor(s) listed above. Please print name:... Signature:... Date:... TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALIST TRAINING COMMITTEE I confirm that the trainee has completed core training and that the Deanery Specialist Training Committee has approved the training module for the doctor, preceptor(s) and programme of training. Please print name:... Signature:... Date:... IT IS THE RESPONSIBILITY OF THE DOCTOR TO OBTAIN THE REQUIRED SIGNATURES FOR THIS FORM BEFORE FORWARDING TO THE COLLEGE

37 Royal College of Obstetricians and Gynaecologists NOTIFICATION OF COMPLETION OF TRAINING MODULE (To be completed by preceptor) I certify that has completed the training module in Intermediate Level Laparoscopic Surgery to my satisfaction. I confirm that I have had regular assessment sessions with the trainee and each of the required skills in the logbook has been attained. Date of commencement of practical training: Date satisfactorily completed theoretical course: / / / / Trainee name:... Trainee signature:... Date:... Preceptor(s) in charge of training. Preceptor name (): Preceptor name (): Preceptor signature (): Preceptor signature (): Date:... Date:... Department address: Department address: Authorised by the Chairman of the Deanery Specialist Training Committee Please print name:... Signature:... Date:... This certificate of completion of training should be sent to the Special Skills Secretary, Postgraduate Training Department, RCOG, Sussex Place, Regent s Park, London NW RG.

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