Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Optional Laparoscopic Urogynaecology
Introduction:
This optional module is designed to provide training in laparoscopic urogynaecology. It is intended to be completed with the subspecialty training programme in
urogynaecology. Successful completion will provide a clinical foundation to offer laparoscopic urogynaecology procedures for managing women with pelvic floor
dysfunction. Practitioners should demonstrate a commitment to providing laparoscopic urogynaecology care as part of a comprehensive subspecialist urogynaecology
service.
Learning outcomes:







To be able to select patients who are suitable to be offered laparoscopic urogynaecology
To have a thorough knowledge of the equipment and resources required to deliver safe laparoscopic surgical care including different energy sources
To be able to counsel patients on the benefits, risks and complications of laparoscopic procedures and obtain consent
To undertake laparoscopic sacrocolpopexy and sacrohysteropexy
To have the opportunity to observe other laparoscopic urogynaecology procedures
To understand regional referral pathways for complex and recurrent cases
To be able to use evidence-based guidelines and write new guidelines when needed
1 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Section 1: Preparation for surgery
Knowledge criteria
Patient selection:
ASA score / fitness
Assessment of suitability of
condition for laparoscopic
surgery
Knowledge of appropriate
preoperative investigations
Knowledge of appropriate
alternative opitons
Effect of previous surgery
Impact of body mass
Thorough counselling / consent of woman:
Alternatives
Risks
GMP
Clinical competency
1
Appropriately select suitable patients
Use of synthetic mesh
Properties of mesh
Counsel regarding mesh complications
including infection, erosion and extrusion
Auditing surgical outcomes
GMP
Understand importance of appropriate selection of
woman
Have an understanding of how history, investigations
and careful counselling impact on patient selection
Professional skills and attitudes
Able to exhibit knowledge of selection
criteria
Able to apply knowledge of patient
selection criteria to clinical situation
GMP
Training support
Evidence/assessment
Tailored clinical
experience under
supervision
Case logbook including
complications
CbD
Observation of,
assisting and discussion
with senior medical
staff
MSF (TO1 and TO2)
Personal study
Appropriate
postgraduate education
courses
Select appropriate mesh and counsel patient regarding
benefits and risks of mesh use
Able to apply up to date knowledge and
guidelines to mesh selection and use
Uses BSUG audit database
Commitment to audit of procedures
according to guidelines
Appropriate guidelines
and articles on mesh
use
Support for BSUG
database
Recorded outcome on BSUG
database
2 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Section 2: Surgical procedures and skills
Learning outcomes:
To be able to perform and understand the place of the following:

Appropriate laparoscopic entry techniques
- Hassan
- Palmer’s point
- Non-standard placement of ports

Safe use of appropriate energy source

Suturing

Knot tying
- Intra-corporeal
- Extra-corporeal

Tests for bladder and bowel integrity

Recognise and initially manage complications:
- Urinary tract
- Gastrointestinal tract
- Haemorrhage
- Late complications
Knowledge criteria
GMP
Knowledge of relevant anatomy including
anatomy of sacral promontory
Clinical competency
GMP
Proficiency in Hassan and Palmer’s point entry
techniques
Ability to perform procedure
GMP
Training support
Evidence/assessment
Appropriate reading
and courses
MSF (TO1 and TO2)
Understand the principles underlying
these techniques
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
Professional skills and attitudes
Log of experience and
competence
CbD
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
Ability to safely perform these procedures
and a thorough understanding of the
safety checks required before activating
the energy source
Tailored clinical
experience and
appropriate theoretical
training
Trouble shooting
Understand the principles of port site closure
and the need to avoid port site hernia or
damage underlying structures
Ability to safely close port sites using appropriate
needles and sutures
Ability to close port sites
Tailored clinical
experience and practice
OSATS for Palmer’s point and
Hassan
3 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Knowledge criteria
GMP
Ability to competently suture using
laparoscopic needle holders
Clinical competency
GMP
Professional skills and attitudes
GMP
Training support
Evidence/assessment
Proficiency in competently suturing and tying the
appropriate surgical knots
Ability to perform these procedures
Tailored clinical
experience and
practice
OSATS knot tying
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 perform these procedures
Tailored clinical
experience and
practice
OSATS
Ability to undertake primary bladder closure when
appropriate
Ability to perform primary bladder repair
when appropriate
Tailored clinical
experience and
practice
CbD
Understand principles of ureteric anastomosis
Understand the principles procedures
Ability to control major haemorrhage until appropriate
help available and understand the principles
underlying the repair of major vessels
Understand the principles underlying the
repair of major vessels underlying these
Recognition of delayed onset complications
such as peritonitis, ileus, faecal
contamination or urinary leakage
Recognition of the signs and symptoms of intraabdominal trauma and the use of appropriate
investigations
Ability to recognise and deal with intraabdominal trauma
Tailored clinical
experience and
practice
CbD
The ability to start appropriate initial
management and understand the principles
of subsequent management
The ability to seek appropriate support e.g General
Surgeon, Urologist, Intensive Care Specialist
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
Ability to visually check the ureter through its pelvic
course and pass the appropriate ureteric catheter
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 anastamosis and reimplantation
Recognise and be able to control
haemorrhage
4 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Competence level
Not required
Laparoscopic Urgoynaecology Logbook
Level 1
Date
Level 2
Signature
Date
Signature
Level 3
Date
Signature
Section 1: Preparation for surgery
Patient selection
Surgical audit
Section 2: Surgical procedures and skills
Knowledge of anatomy
Laparoscopic entry and closure
Safe use of energy sources
Suturing and knot tying
Intra-operative management of complications
Postoperative care and management of complications
Perform laparoscopic sacrocolpopexy
Perform laparoscopic sacrohysteropexy
5 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
Training Courses or sessions
Date
Title
Signature of educational supervisor
Authorisation of signatures (to be completed by the clinical trainers)
Name of clinical trainer (please print)
Signature of clinical trainer
6 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust
Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies
COMPLETION OF Laparoscopic Urogynaecology Module
I confirm that all components of the module have been successfully completed:
Date
Name of educational supervisor
Signature of educational supervisor
7 GMC approved as of 15 April 2015
GMC Good Medical Practice (GMP) Domains:
Domain 1: Knowledge, skills and Performance
Domain 2: Safety and quality
Domain 3: Communication, Partnership and Teamwork.
Domain 4: Maintaining Trust