OSATS, advanced laparoscopic surgery for the excision of benign disease ATSM

This page sets out the OSATS requirements for the ATSM in advanced laparoscopic surgery for the excision of benign disease.

You have to be competent in:

• Cystoscopy
• Excise rectovaginal endometriosis
• Excision of side-wall endometriosis
• Hassan entry
• Knot tying
• Laparoscopic myomectomy
• Palmer’s point entry
• Pelvic survey in endometriosis
• Total laparoscopic hysterectomy

Cystoscopy

Items under observation:

• Obtains appropriate consent
• Cleans and drapes correctly
• Chooses correct scope
• Assembles scope correctly
• Visualises whole bladder
• Identifies ureteric orifices
• Observes the urethra
• Appropriate use of antibiotics
• Empties bladder at the end

Excise rectovaginal endometriosis

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Cleans and drapes correctly
• Patient catheterised
• Correct incisions
• Correct port placements
• Identifies ureters
• Identifies pelvic organs, bladder and rectum
• Checks appendix, liver
• Divides adhesions appropriately
• Dissects ureters safely away from lesion where required
• Incises recto-vaginal space safely
• Identifies rectal involvement
• Excises endometriotic nodule safely
• Closes bowel defect appropriately
• Carries out appropriate bowel integrity test
• Removes and close ports appropriately
• Drains bladder appropriately

Excision of side-wall endometriosis

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Cleans and drapes correctly
• Patient catheterised
• Correct incisions
• Correct port placements
• Identifies ureters
• Identifies pelvic organs, bladder and rectum
• Checks appendix, liver
• Divides adhesions appropriately
• Dissects ureters safely away from lesion
• Excises endometriosis appropriately
• Removes and close ports appropriately
• Drains bladder appropriately

Hassan entry

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Cleans and drapes correctly
• Able to assess indication for chosen technique
• Appropriate incision
• Appropriate dissection
• Correct insertion of port
• Correct closure of port at end

Knot tying

Items under observation:

• Correct port positions
• Appropriate instruments chosen
• Suture inserted in pelvis in appropriate manner
• Correct needle handling and orientation
• Needle passed through tissue correctly
• Knots thrown securely
• Needle removed from abdomen safely

Laparoscopic myomectomy

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Cleans and drapes correctly
• Patient catheterised
• Correct incisions
• Correct port placements
• Appropriate uterine assessment including cavity
• Appropriate uterine incisions
• Appropriate excision of fibroids
• Appropriate closure of uterine defect
• Appropriate retrieval of specimens
• Removes and close ports appropriately
• Use of drains and catheter appropriately

Palmer’s point entry

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Checks NG tube inserted
• Cleans and drapes correctly
• Able to assess indication for chosen technique
• Appropriate incision
• Appropriate insertion of Verres
• Correct insertion of port
• Correct closure of port at end

Pelvic survey in endometriosis

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Cleans and drapes correctly
• Patient catheterised
• Correct incisions
• Correct port placements
• Identifies ureters
• Identifies pelvic organs, bladder and rectum
• Checks appendix, liver
• Performs tubal patency test
• Removes and close ports appropriately
• Drains bladder appropriately

Total laparoscopic hysterectomy

Items under observation:

• Obtains appropriate consent
• Correct use of antibiotics
• Patient positioned correctly on the operating table
• Cleans and drapes correctly
• Patient catheterised
• Correct placement of uterine manipulator
• Correct incisions
• Correct port placements
• Appropriate uterine assessment
• Ureters identified
• Ovarian pedicles divided safely
• Bladder reflected
• Uterine arteries divided safely
• Vaginal incision carried out appropriately
• Vagina closed appropriately
• Removes and close ports appropriately
• Use of drains and catheter appropriately