The aim of this course is to allow residents/fellows and medical students as well as attending physicians to acquire basic level skills in laparoscopic gynecology including hands-on simulation-based training of essential OB-GYN procedures, needed to acquire the skills and core competencies for OB-GYN PGY-3 training.
Hysterectomy, removal of the uterus, is the second most common major operation among women in the United States. Approximately 600,000 hysterectomies are performed yearly in the United States at a cost of nearly $5 billion, according to the Centers for Disease Control and Prevention.
While studies indicate that many hysterectomies can safely and successfully be performed using laparoscopic techniques, the majority of these surgeries are performed abdominally through an “open” laparotomy incision. Despite laparoscopic surgery’s advantages in appropriately selected patients – less postsurgical pain, quicker recovery times and smaller scars — OB/GYN’s have lagged behind other fields in adopting this minimally-invasive approach.
There is a great need for scientifically-validated, advanced surgical simulation training that will assist practicing OB/GYN’s in the transfer of surgical skills from the “open” abdominal hysterectomy approach to the laparoscopic approach, as well as train residents and fellows in the latest techniques for laparoscopic hysterectomy.
The following training course for PGY-4 provides repetitive practice of surgical skills required for the Total Laparoscopic Hysterectomy procedure, in a safe and reproducible environment. The course is intended for practicing OB-GYN surgeons, as well as residents and fellows, who are familiar with basic laparoscopic skills and gynecological procedures.
The course components include:
- FLS Training
- Suturing & Knot Tying
- Ectopic Pregnancy & Oophorectomy
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.
Ectopic Pregnancy & Oophorectomy
Experience a range of patient pathologies and various techniques and surgical instruments. Included are a variety of complications and emergency situations such as bleeding at the implantation site, a ruptured fallopian tube and a blood-filled abdominal cavity.
Total Laparoscopic Hysterectomy Procedure
Participants train in the key components of the procedure: Uterine manipulation, superior pedicle division, bladder mobilization, exposure and division of the uterine vessels and performance of a colpotomy. The course of the ureters may be visualized transperitoneally, or through a retroperitoneal dissection. Either salpingo-oophorectomy or preservation of the adnexa may be performed.
A variety of complications and emergency situations may occur during the key steps of the procedure including: Ureteral injuries, injury to the bladder or bowel and uterine artery bleeding. The simulation also provides the surgeon with flexibility to determine the extent of bladder mobilization, identification of the course of the ureters, and recognition of the cervico-vaginal margin during colpotomy. All the key decision points of the actual procedure are incorporated into a realistic surgical environment. The curriculum provides a complete educational solution, including videos of individual steps of the real procedure, step-by-step procedural guidance and comprehensive objective performance metrics.
- 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.
- Safely fundamental GYN procedures: Ectopic pregnancy and salpingo-oophorectomy, in a simulated environment.
- Safely perform an advanced gynecological procedure, Total Laparoscopic Hysterectomy, in a simulated environment.
Obstetrics and Gynecology
Prerequisite: Completed basic laparoscopic skills training.
It is recommended to include a cognitive skills module at the beginning of the training program.
Suggested Time Length
The Laparoscopic Essential Tasks, Suturing, Essential Gynecology and Hysterctomy Modules were created in collaboration with:
- Amir Szold, MD, Medical Director, Assia Medical Group, Assuta Hospital, Tel Aviv, Israel.
- Chen Goldchmit, Director of Endoscopic Unit, Rabin Medical Center, Israel.
- Eric Jelovsek, M.D. , Assistant Professor of Surgery, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University.
- Larry R. Glazerman, MD, MBA, FACOG, Associate Professor and Director Minimally Invasive GYN Surgery, Department of Obstetrics and Gynecology, Co-Director, USF Center for the Advancement of Minimally-Invasive Pelvic Surgery, USF Health.
- Jonathon Solnik, MD, Director, Minimally Invasive Gynecologic Surgery, Assistant Residency Program Director, Dept OB/Gyn, Cedars-Sinai Medical Center, Assistant Clinical Professor, Dept OB/Gyn, The David Geffen School of Medicine at UCLA.
- Goldenberg Mordechai, Roy Mashiach, MD, Minimally Invasive Gynecologic Surgery, Sheba Medical Center at Tel Hashomer.
- Moty Pansky, President, Israel Society Of Gynecologic Endoscopy (ISGE), Director, Gyn. Endoscopy Unit, Vice Chairman, Division of Ob/Gyn, Asaf Harofe Medical Center, Zerifin, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel.
- Stuart Hart, MD, FACOG, FACS, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Co-Director, USF Center for the Advancement of Minimally-Invasive Pelvic Surgery, Medical Director, Tampa Bay Research and Innovation Center (TBRIC) University of South Florida College of Medicine.
- 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.
- 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