Minimally Invasive Surgery PGY4

EDUCATIONAL GOALS & OBJECTIVES

The PGY4 resident who opts to complete an elective Minimally Invasive Surgery rotation will be able to gain comprehensive surgical knowledge and operative experience, with a focus on conditions treated using advanced laparoscopic techniques. These include hernias, morbid obesity, gastroesophageal reflux, and diseases of the spleen. Residents will gain proficiency in advanced laparoscopic procedures such as laparoscopic inguinal hernia repair, laparoscopic sleeve gastrectomy, and laparoscopic splenectomy.

Faculty will facilitate learning in the 6 core competencies as follows:

Patient Care

I. Communicate effectively while demonstrating empathy and respect when interacting with patients and their families.

II. Become proficient in coordinating management decisions with input from multiple surgical and medical subspecialists.

III. Gather essential and accurate information about patients, particularly concerning hernias, morbid obesity, gastroesophageal reflux, and splenic diseases.

IV. Develop treatment plans based on the analysis of diagnostic information, current scientific evidence, and clinical judgment.

V. Under appropriate and indirect supervision, and with intraoperative assistance, perform essential surgical procedures relevant to the area of practice, with particular focus on the following:

Independently gain intra-peritoneal access for laparoscopic surgery
Independently place ports for all basic laparoscopic and advanced procedures.
Perform dissection in a laparoscopic cholecystectomy with minimal guidance.
Perform the majority of short gastric mobilization and stomach division during a laparoscopic sleeve gastrectomy.
Complete the majority of a laparotomy, lysis of adhesions, and mesh suture placement for open ventral hernia repair.

Medical Knowledge

I. Inguinal and Femoral Hernia

Gain and apply a thorough understanding of the anatomy and physiology of both primary and recurrent inguinal and femoral hernias to effectively plan treatment.
Create a detailed intra-operative dissection plan using anatomical knowledge for laparoscopic groin hernia repair, specifying precise locations.
Formulate a comprehensive post-operative care plan for uncomplicated groin hernia repairs, providing adequate pain relief and proper wound care.
Develop a plan to accurately identify post-operative groin hernia complications by evaluating patient symptoms and available data.
Implement safe and effective strategies for managing post operative complications such as hematoma, urinary retention, and surgical site infections, and ensure faculty are informed if reoperation might be necessary.

II. Ventral and Incisional Hernia

Formulate treatment plans for patients using comprehensive knowledge of abdominal wall anatomy and the physiology of different types of ventral hernias, such as umbilical, epigastric, incisional, and Spigelian hernias.
Determine the best treatment options for each patient’s ventral hernia, considering both open and laparoscopic surgical methods.
Incorporate principles of anatomy and techniques for component separation in abdominal wall reconstruction into clinical decisions and patient care.
Construct treatment plans that mitigate the risks associated with both open and laparoscopic ventral hernia repairs during surgery.
Formulate a comprehensive post-operative care plan for ventral hernia repairs, providing adequate pain relief and proper wound care.
Implement safe and effective strategies for managing post operative complications such as hematoma, urinary retention, and surgical site infections, and ensure faculty are informed if reoperation might be necessary.

III. Morbid Obesity and Bariatric Surgery

Create comprehensive treatment plans for morbidly obese patients by following the latest guidelines for surgical obesity management to identify suitable candidates.
Compare and evaluate the different surgical procedures available for obesity treatment, with a focus on laparoscopic gastric bypass, sleeve gastrectomy, and common revision surgeries.
Develop a sound rationale for selecting one procedure over another.
Review a patient’s medical history to identify common contraindications for gastric bypass or sleeve gastrectomy.
Provide safe and effective post-operative care for bariatric surgery patients, including dietary guidance and management of type 2 diabetes.
Use patient history, physical exams, and other relevant data to accurately diagnose and treat post-operative complications of bariatric surgery.
Identify and manage post-operative complications such as leaks, bleeding, and venous thromboembolism effectively, in collaboration with faculty.
Apply knowledge to determine when reoperation might be necessary for bariatric surgery patients.

IV. Gastroesophageal Reflux and Para-esophageal Hernia

Develop a treatment plan for patients with GERD based on a thorough understanding of esophageal and gastric physiology, including the function and location of the gastro-esophageal junction.
Integrate their knowledge of the pathophysiology with the clinical presentation of gastro-esophageal reflux disease (GERD).
Compare and contrast the classic and atypical symptoms of GERD.
Use anatomical and pathophysiological knowledge to assess patients with para-esophageal hernias.
Distinguish between the urgent and chronic symptoms associated with para-esophageal hernias.
Evaluate and compare various treatment options for GERD, with a focus on laparoscopic methods.
Compare and contrast complete and partial fundoplication, both in terms of technique and rationale.
Plan strategies to address potential intra-operative complications during both open and laparoscopic hiatal hernia repairs and fundoplication procedures.
Develop a plan to manage both short-term and long-term complications following hiatal hernia repair and fundoplication. x. Identify post-operative complications and demonstrate safe and effective management in conjunction with faculty, including esophageal perforation, bleeding, dysphagia that may indicate a need for reoperation.

V. Diseases of the Spleen

Utilize knowledge of common diseases that may require splenectomy, particularly those treated laparoscopically, to inform decision-making.
Develop strategies to address common intra-operative complications associated with both open and laparoscopic splenectomy.
Demonstrate safe and effective post-operative management of splenectomy, especially recognition of post-operative sign that indicate bleeding and the need for reoperation.

VI. Advance Minimally Invasive Surgery

Foregut, mid gut, hind gut, as well as advance solid organ surgeries

Practice Based Learning

I. Able to access current clinical practice guidelines to apply evidence based strategies to patient care.

II. Develop skills in evaluating new studies in published literature, through Journal Club and independent study

III. Implement constructive feedback from healthcare team members to improve performance and patient outcomes.

Interpersonal and Communication Skills:

I. Demonstrate clear and organized electronic and verbal communication skills to build rapport with patients and families, convey information to healthcare professionals, and ensure timely documentation in patient charts.

II. Develop interpersonal skills that promote effective collaboration with patients, their families, and other healthcare professionals.

III. Create and sustain a therapeutic and ethically sound relationship with patients.

IV. Work effectively as both a member and leader of a healthcare team or other professional group.

Professionalism:

I. Demonstrate a strong commitment to carrying out professional responsibilities.

II. Communicate with patients in a manner respectful of gender, cultural, religious, economic, and educational differences

III. Advise patients and families on diagnostic and treatment options, including end-of-life care.

IV. Offers timely consultations when requested.

V. Maintains reliability, punctuality, and accountability for one's actions in both the operating room and clinic.

VI. Safeguards patient confidentiality.

System-Based Practice

I. Demonstrate an awareness of and responsiveness to established quality measures, risk management strategies, and cost of care within our system.

II. Advocate for quality patient care and assist patient in dealing with system complexities.

III. Collaborate with health care managers and health care providers to assess, coordinate and improve health care and know how these activities can affect system performance