Section 1: Preparation for surgery Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Patient selection: ASA score / fitness Assessment of suitability of condition for laparoscopic surgery Knowledge of appropriate preoperative investigations Knowledge of appropriate alternative options Effect of previous surgery Impact of body mass Thorough counselling / consent of woman: Alternatives Risks Use of synthetic mesh Properties of mesh Counsel regarding mesh complications including infection, erosion and extrusion Auditing surgical outcomes 1 3,4 2,3 2 Appropriately select suitable patients Understand importance of appropriate selection of woman Have an understanding of how history, investigations and careful counselling impact on patient selection Select appropriate mesh and counsel patient regarding benefits and risks of mesh use Uses BSUG audit database 1,3,4 1 1 1,2 2 Able to exhibit knowledge of selection criteria Able to knowledge of patient selection criteria to clinical situation Able to apply up to date knowledge and guidelines to mesh selection and use Commitment to of procedures according to guidelines 1 1,2,3 1,2 2,3,4 Tailored clinical experience under supervision Observation of, assisting and discussion with senior medical staff Personal study Appropriate postgraduate education courses Appropriate guidelines and articles on mesh use Support for BSUG database Case logbook including complications CbD MSF (TO1 and TO2) Recorded outcome on BSUG database
Section 2: Laparoscopic surgical procedures and skills Learning outcomes: To be able to perform and understand the of the following: Appropriate laparoscopic entry techniques - Hassan - Palmer’s - Non-standard placement of ports Safe use of appropriate energy source Suturing Knot tying - Intra-corporeal - Extra-corporeal for bladder and bowel integrity Recognise and initially manage complications: - Urinary tract - Gastrointestinal tract - Haemorrhage - Late complications Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Knowledge of relevant anatomy including anatomy of sacral promontory Safe laparoscopic entry and choosing correct entry for each patients including use of veress needle, open entry, direct vision entry, palmer’s point entry Understand the principles of electrosurgery, ultrasound and other future energy sources 1 1 1 Proficiency in Hassan and Palmer’s point entry techniques Be able to demonstrate ability to use bipolar effectively and have at least one energy source used for cutting i.e. monopolar or ultrasound. Have an understanding of the principles underlying all the others 1 1 Ability to perform procedure Understand the principles underlying these techniques Ability to safely perform these procedures and a thorough understanding of the safety checks required before activating the energy source Trouble shooting 1 1 1 1 Appropriate reading and courses Tailored clinical experience and appropriate theoretical training MSF (TO1 and TO2) Log of experience and competence CbD
Understand the principles of port site closure and the need to port site hernia or damage underlying structures 1 Ability to safely close port sites using appropriate needles and sutures 1 Ability to close port sites 1 Tailored clinical experience and practice OSATS for Palmer’s point and Hassan Ability to competently suture using laparoscopic needle holders Ability to undertake intra-corporeal and extracorporeal knot tying Ability to inspect bladder, ureter, small and large bowel for perforation or damage, recognition of this and undertake appropriate special tests such as air insufflation and use of dyes Recognition of bowel and bladder complications, assessment of these and ability if appropriate to perform primary repair, involving other surgical specialities as appropriate Understand the principles of more complex repairs such as segmental bowel resection and ureteric anastomosis and reimplantation Recognise and be able to control haemorrhage Recognition of delayed onset complications such as peritonitis, ileus, faecal contamination or urinary leakage The ability to appropriate initial management and understand the principles of subsequent management 1 1 1 1,2 1 1 1 1 Proficiency in competently suturing and tying the appropriate surgical knots Ability to carry out visual inspection of bowel, carry out air insufflation and dye tests. Ability to check integrity of bladder using visual inspection and dye tests. Ability to visually check the ureter through its pelvic course and pass the appropriate ureteric catheter Ability to undertake primary bladder closure when appropriate Understand principles of ureteric anastomosis Ability to control haemorrhage until appropriate help available and understand the principles underlying the repair of major vessels Recognition of the signs and symptoms of trauma and the use of appropriate investigations The ability to seek appropriate support e.g. General Surgeon, Urologist, Intensive Care Specialist 1 1 1 1 1,2,3 1,2 1,2,3 Ability to perform procedures Ability to perform procedures Ability to perform primary bladder repair when appropriate Understand the principles procedures Understand the principles underlying the repair of major vessels underlying these Ability to recognise and deal with trauma 1 1 1 1 1 1,2,3 Tailored clinical experience and practice Tailored clinical experience and practice Tailored clinical experience and practice Tailored clinical experience and practice OSATS knot tying CbD CbD