Intermediate Level Laparoscopic Surgery - RCOG · SPECIAL SKILLS TRAINING MODULE Intermediate Level Laparoscopic Surgery APRIL 2005 Royal College of Obstetricians and Gynaecologists

SPECIAL SKILLS TRAINING MODULE

Intermediate LevelLaparoscopic Surgery

APRIL 2005

Royal College of Obstetricians and Gynaecologists in collaboration with the British Society for Gynaecological

Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists

Registered Charity No. 213280

© 2005 Royal College of Obstetricians and Gynaecologists

Further copies of this module can be obtained from:

Postgraduate Training DepartmentRoyal College of Obstetricians and Gynaecologists27 Sussex PlaceRegent’s ParkLondonNW1 4RG

Telephone: +44 (0) 20 7772 6200Facsimile: +44 (0) 20 7723 0575website: www.rcog.org.uk

Printed by Manor Press, Unit 1, Priors Way, Maidenhead, Berks. SL6 2EL.

CONTENTS

INTRODUCTION 3Entry criteria 3Training programme components 3The logbook (guide to learning) 5

TRAINING DETAILS 7

RECORD OF ATTENDANCE 8–24Operating Lists 8–19Outpatient Clinics 20–22Laboratory Sessions 23–24

AUDIT 25

GENERIC SKILLS 26

ADHESIONS 27

ECTOPIC PREGNANCY 27

OVARY 28

ENDOMETRIOSIS 28

APPENDIX 1: CONTENTS OF THEORETICAL COURSE 29

REGISTRATION FORM 31

REGISTRATION FORM FOR NON-TRAINING GRADES 33

NOTIFICATION OF COMPLETION OF TRAINING MODULE 35

Intermediate Level Laparoscopic Surgery Special Skills Training Module 3

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INTRODUCTION

Competence in laparoscopic surgery arms the gynaecologist with a powerful diagnostic and thera-peutic skill. The magnified endoscopic image and instrumentation provide advantages that have noequivalent in open surgery. This module will facilitate intermediate level laparoscopic capabilitywith 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 postoperativecomplications and know when to refer

� understand and use energy sources safely.

Entry criteriaAs special skills training should follow the completion of core training, the following criteria mustbe met:

1. The trainee must have passed Part 2 MRCOG or hold an equivalent qualification.

2. The trainee must have satisfactorily completed the Core Logbook requirements.

3. The trainee must have obtained a satisfactory year three RITA.

4. 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 aremet.

Specialist Registrars with fixed term training appointments (FTTA) who wish to register with theRCOG for special skills training should also fulfil the above criteria.

Training programme componentsThe following are essential components of the training programme, and all of them have to becompleted.

1. Training must be undertaken under the supervision of an identified preceptor. The preceptormust be skilled in laparoscopic surgery and will supervise at least 30 theatre sessions in whichthe trainee will be primary surgeon for part of at least one operative procedure. The record ofattendance should document all the cases which took place on each list which the traineeattended. 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.


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2. The trainee should attend at least ten outpatient sessions under the supervision of the preceptorwhere focus is directed on patient selection, counselling and consent for laparoscopic pro-cedures.

3. The trainee should attend regular laboratory sessions focused on exercises and techniques, asguided by their preceptor. Sessions should exceed 30 minutes and total not less than 30 hours.

4. The trainee will keep a record of attendance at lists, out patient clinics and lab sessions.

5. Trainees should complete a clinical audit on a subject related to the use of laparoscopicsurgery in the management of gynaecological conditions. This should be completed to the pre-ceptor’s satisfaction.

6. 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 otherthan the preceptor. In these circumstances, it is the preceptor’s duty to ensure that theprofessional to whom the duty of training is delegated is sufficiently competent, willing andable 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.

7. The preceptor must demonstrate a regular laparoscopic workload, containing at least oneoperating list per week at which laparoscopic surgery is performed. He or she must ensure theprovision of camera systems, insufflation and instrumentation of appropriate quality to provideexcellence in training. They must also ensure adequate dry laboratory facilities to allow thepractice of laparoscopic skills within a risk-free environment. The preceptor should preferablybe a member of the BSGE.

8. Trainees should obtain an application form for special skills training from the PostgraduateTraining Department of the RCOG and ensure that it is completed. The special skills trainingplans of the trainee should be discussed at the year two RITA. During SpR year three, thetrainee should obtain the chosen module and application forms from the RCOG PostgraduateTraining Department, make contact with a preceptor in their chosen module, discuss rotationswith the Deanery Specialist Training Committee (DSTC) and ensure that their application formis completed. At the Year three RITA assessment, the trainee should ask the Chairman of theDSTC to sign the application form in support of the module and send a copy of the completedform to the RCOG.

9. Trainees must attend a BSGE/RCOG approved theoretical course that should provide theessential knowledge component of training for this module. It is expected that trainees willalso supplement their knowledge by reading standard textbooks and other literature. Thetheoretical course can be attended at any time after registration and the core knowledgegained 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 thesatisfaction 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 PostgraduateTraining Department at the RCOG.

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The logbook (guide to learning)This logbook defines the skills required for intermediate level laparoscopic surgery. Completion ofthe logbook will allow the preceptor and trainee to monitor progress and identify deficiencies overthe course of training. It is important to note that the logbook is a record of competence rather thanexperience. 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 1 Requires direct supervision.

Level 2 Competent to perform the exercise independently.

It is imperative that all participants appreciate that the trainee’s progress has to meet standardsthat satisfy the preceptor. At the end of the training programme, the preceptor has to certify thatthe skills attained by the trainee are to his or her satisfaction.


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TRAINING DETAILS


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Trainee name:

Address:

Email:

National Training Number:

Preceptor:

Address:

Email:

Date of commencement of training:

Date of attendance at theoretical course:

Date of completion of training:

RECORD OF ATTENDANCE

Operating Lists


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Date of list Procedure Role Preceptor’sA, B, C, D* signature

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* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant;D: observer


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Outpatient clinicsAt least ten clinics under supervision of the preceptor must be attended. Keep a record of relevantpatients, seen with or discussed with your preceptor.


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Date Diagnosis/complaint Preceptor’s signature




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Laboratory sessionsA variety of exercises must be undertaken, including suturing and knot tying. Sessions can last avariable length of time but a total of 30 hours should be completed, spread over the duration oftraining. It is recommended that skills are maintained by laboratory practice at least once a month.


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Date Duration of session/exercise Preceptor’s signature


Laboratory sessionsA variety of exercises must be undertaken, including suturing and knot tying. Sessions can last avariable length of time but a total of 30 hours should be completed, spread over the duration oftraining. It is recommended that skills are maintained by laboratory practice at least once a month.


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AUDIT


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Audit

Summary

Date completed

Preceptor’s signature

GENERIC SKILLS

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SKILL Level 1 Level 2

Supervised Independent Preceptor’s signature

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

NB: If, during the training period, the trainee does not experience all of these complications, then the preceptor can sign offthe competence if he or she is satisfied that the trainee has the ability to recognise and treat them appropriately.

ADHESIONS


Supervised Independent Preceptor’s signature*

Patient selection

Preoperative counselling

Perform adhesiolysis

Postoperative care



Patient selection


Perform salpingectomy

Perform salpingotomy

Postoperative care

ECTOPIC PREGNANCY




Patient selection


Perform excision/ablation ofperitoneal endometriosis

Perform excision/ablation ofendometrioma

Postoperative care

ENDOMETRIOSIS

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Patient selection


Perform ovarian cystectomy

Perform oophorectomy

Postoperative care

OVARY

APPENDIX 1

Contents of theoretical courseAttendance 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 coveringthe 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.


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To be completed and returned to the:Special Skills Secretary,Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.

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

Please insert name of module:

Royal College of Obstetricians and Gynaecologists

SPECIAL SKILLS TRAINEE REGISTRATION FORM

TO BE COMPLETED BY PRECEPTOR(S)

Name of preceptor(s) in charge of training (please print name):

1. Name: .................................................................. 2. Name: ..................................................................

Post: ......................................................................... Post: .........................................................................

Department address: Department address:

................................................................................. .................................................................................

................................................................................. .................................................................................

................................................................................. .................................................................................

I agree to provide the training necessary for the completion of this Special Skills Module.

Preceptor signature (1): Preceptor signature (2):

................................................................................. .................................................................................

Date: ........................................................................ Date: ........................................................................

TO BE COMPLETED BY THE RCOG COLLEGE TUTORI confirm that the trainee can undertake this module of Special Skills Training under the supervision of thepreceptor(s) listed above.

Please print name:

................................................................................. Signature: .................................................................

Date: ........................................................................

TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALISTTRAINING COMMITTEEI confirm that the trainee has completed core training and that the Deanery Specialist Training Committee hasapproved 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 THISFORM BEFORE FORWARDING TO THE COLLEGE

To be completed and returned to the:Special Skills Secretary,Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.

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

Please insert name of module:


SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES

TO BE COMPLETED BY PRECEPTOR(S)

Name of preceptor(s) in charge of training (please print name):

1. Name: .................................................................. 2. Name: ..................................................................

Post: ......................................................................... Post: .........................................................................


................................................................................. .................................................................................

................................................................................. .................................................................................

................................................................................. .................................................................................

I agree to provide the training necessary for the completion of this Special Skills Module.


................................................................................. .................................................................................

Date: ........................................................................ Date: ........................................................................

TO BE COMPLETED BY THE CLINICAL DIRECTORI confirm that the doctor can undertake this module of Special Skills Training under the supervision of thepreceptor(s) listed above.

Please print name:

................................................................................. Signature: .................................................................

Date: ........................................................................

TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALISTTRAINING COMMITTEEI confirm that the trainee has completed core training and that the Deanery Specialist Training Committee hasapproved 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 THISFORM BEFORE FORWARDING TO THE COLLEGE


NOTIFICATION OF COMPLETION OF TRAINING MODULE(To be completed by preceptor)

I certify that

has completed the training module in Intermediate Level Laparoscopic Surgeryto 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 (1): Preceptor name (2):

................................................................................. .................................................................................


................................................................................. .................................................................................

Date: ........................................................................ Date: ........................................................................


................................................................................. .................................................................................

................................................................................. .................................................................................

................................................................................. .................................................................................

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, 27 Sussex Place, Regent’s Park, London NW1 4RG.

Documents

Intermediate Level Laparoscopic Surgery - RCOG · SPECIAL SKILLS TRAINING MODULE Intermediate Level Laparoscopic Surgery APRIL 2005 Royal College of Obstetricians and Gynaecologists