General Surgery PGY-3
This curriculum aims to provide the participant with the essential simulation assignments needed to acquire the skills and core competencies for General Surgery PGY-3 training.
The course components include:
- FLS Training
- Knot Tying
- Freehand Suturing/Knot Tying Practice
- Laparoscopic Cholecystectomy Procedure (Basic Level)
- Laparoscopic Cholecystectomy Procedure (Advanced Level)
- Incisional Hernia
Tasks include peg transfer, pattern cutting and placement of ligating loop.
Suturing and Knot Tying
Learn and practice basic suturing techniques for all fields of laparoscopic surgery: Needle loading and needle insertion techniques, knot tying techniques such as half knot, square knot, and ligature knot and practice performing interrupted and continuous suture. Tasks are illustrated by instructional videos.
Laparoscopic Cholecystectomy Procedure – Proficiency-Based Training
Patient cases with easy to difficult anatomical variations to the cystic duct and positions of arteries, which may otherwise not be experienced during a training period. The component enables free-style training using different techniques, alternative approaches, and acquisition of the skill and knowledge necessary to safely cope with possible complications.
Training within a proficiency-based virtual reality curriculum may reduce errors during real surgical procedures. The laparoscopic cholecystectomy training within this curriculum is based on Development of a Virtual Reality Training Curriculum for Laparoscopic Cholecystectomy (Darzi et al. British Journal of Surgery 2009; 96: 1086–1093). The aim of the training curriculum is for an individual to acquire skills and reach a predetermined level of proficiency before progressing to more challenging cases.
Provides surgeons with a true-to-life experience of laparoscopic incisional hernia repair in a controlled and safe environment. Trainees gain an in-depth understanding of abdominal anatomy, skills for carefully separating the adhesion to expose the hernia defect, appreciation of potential complications, and are able to practice safe use of prosthetic mesh and devices used to fixate, suture and staple the mesh.
- To become accustomed to the fulcrum effect, laparoscopic depth perception and eye hand coordination.
- To practice coordinated hand movements.
- To accurately and efficiently grasp objects and transfer them to designated areas.
- To train on the use of laparoscopic scissors for cutting.
- To become familiarized with the method of placing a ligating loop.
- To learn and practice needle loading and needle insertion techniques.
- To perform interrupted and continuous suture.
- To become familiarized with different knot tying techniques such as half knot, square knot, and ligature and surgeon`s knot.
- To familiarize with the pitfalls of easy to difficult anatomical variations to the cystic duct and positions of arteries.
- To practice the skills and techniques essential for the laparoscopic cholecystectomy procedure in a simulated environment.
- To practice the skills and techniques essential for the laparoscopic hernia procedure in a simulated environment.
General Surgery PGY-3
Prerequisite: Completed basic laparoscopic skills training.
Suggested Time Length
The Suturing and Laparoscopic Cholecystectomy and Incisional Hernia modules were developed in collaboration with:
- Amir Szold, MD, Medical Director, Assia Medical Group, Assuta Hospital, Tel Aviv, Israel.
- Dr. Eduardo Parra-Davila, Colon & Rectal Surgery and General Surgery, Boca Raton, Florida.
- Jeffrey L. Ponsky, M.D., Oliver H. Payne Professor and Chairman, Department of Surgery, CWRU School of Medicine, Surgeon in Chief, University Hospitals, Case Medical Center, Cleveland, Ohio
- Rajesh Aggarwal MD PhD MA FRCS, Instructor in Gastrointestinal Surgery, University of Pennsylvania.
- Yaron Munz, MD, Senior Surgeon, Dept. of General Surgery, Rabin Medical Center, Golda Campus – Hasharon. Director of Surgical Simulation, The Israel Centre for Medical Simulation, Sheba Medical Centre, Tel Hashomer.