SPECIAL SKILLS TRAINING MODULE
Intermediate Level
Laparoscopic Surgery
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 Department
Royal College of Obstetricians and Gynaecologists 27 Sussex Place Regent’s Park London NW1 4RG Telephone: +44 (0) 20 7772 6200 Facsimile: +44 (0) 20 7723 0575 website: www.rcog.org.uk
CONTENTS
INTRODUCTION 3
Entry criteria 3
Training programme components 3
The logbook (guide to learning) 5
TRAINING DETAILS 7 RECORD OF ATTENDANCE 8–24 Operating Lists 8–19 Outpatient Clinics 20–22 Laboratory 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
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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 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:
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 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.
1. Training must be undertaken under the supervision of an identified preceptor. The preceptor
must be skilled in laparoscopic surgery and will supervise at least 30 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,
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2. 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 pro-cedures.
3. The trainee should attend regular laboratory sessions focused on exercises and techniques, as
guided 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 laparoscopic
surgery 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 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.
7. 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.
8. 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.
6 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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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 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 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.
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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
10 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer
RECORD OF ATTENDANCE
Operating Lists
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
RECORD OF ATTENDANCE
Operating Lists
12 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer
RECORD OF ATTENDANCE
Operating Lists
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
RECORD OF ATTENDANCE
Operating Lists
14 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer
RECORD OF ATTENDANCE
Operating Lists
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
RECORD OF ATTENDANCE
Operating Lists
16 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer
RECORD OF ATTENDANCE
Operating Lists
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
RECORD OF ATTENDANCE
Operating Lists
18 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer
RECORD OF ATTENDANCE
Operating Lists
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
RECORD OF ATTENDANCE
Operating Lists
20 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
* Roles: A: primary surgeon for whole procedure; B: primary surgeon for part of procedure (state which part); C: assistant; D: observer
RECORD OF ATTENDANCE
Operating Lists
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Date of list Procedure Role Preceptor’s A, B, C, D* signature 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
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.
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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.
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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.
24 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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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 30 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.
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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 30 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.
26 Special Skills Training Module Intermediate Level Laparoscopic Surgery
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AUDIT
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Audit Summary Date completedGENERIC SKILLS
28 Special Skills Training Module Paediatric & Adolescent Gynaecology
PAEDIA
TRIC & ADOLESCENT GYNAECOLOGY
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 off the competence if he or she is satisfied that the trainee has the ability to recognise and treat them appropriately.
ADHESIONS
SKILL Level 1 Level 2
Supervised Independent Preceptor’s signature*
Patient selection
Preoperative counselling Perform adhesiolysis Postoperative care
SKILL Level 1 Level 2
Supervised Independent Preceptor’s signature*
Patient selection
Preoperative counselling Perform salpingectomy
SKILL Level 1 Level 2
Supervised Independent Preceptor’s signature*
Patient selection Preoperative counselling Perform excision/ablation of peritoneal endometriosis Perform excision/ablation of endometrioma Postoperative care
ENDOMETRIOSIS
30 Special Skills Training Module Paediatric & Adolescent Gynaecology
SKILL Level 1 Level 2
Supervised Independent Preceptor’s signature* Patient selection
Preoperative counselling Perform ovarian cystectomy Perform oophorectomy Postoperative care
APPENDIX 1
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.
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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 ■■
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 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
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 ■■
Please insert name of module:
Royal College of Obstetricians and Gynaecologists
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 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
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 (1): Preceptor name (2):
... ...
Preceptor signature (1): Preceptor signature (2):
... ...
Date: ... Date: ...
Department address: Department address:
... ...
... ...
... ...
Authorised by the Chairman of the Deanery Specialist Training Committee
