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OSATS, urogynaecology and vaginal surgery ATSM

This page sets out the OSATS requirements for the ATSM in urogynaecology and vaginal surgery.

You have to be competent in:

Anterior repair

Items under observation:

  • Appropriate use of thromboprophylaxis and antibiotic prophylaxis
  • Ensure suitable positioning, cleaning and draping
  • Empty bladder
  • Considers local anaesthetic infiltration and hydrodissection
  • Appropriate incision
  • Selects and uses instruments appropriately
  • Selection of appropriate suture materials and needles
  • Appropriate and adequate dissection
  • Appropriate insertion of fascial plication sutures
  • Management of bleeding (if required)
  • Trim redundant vaginal epithelium; appropriate closure technique
  • Assess need for pack and catheter
  • Apropriate use of asistant
  • Knowledge of electrocautry

Diagnostic cystourethroscopy (+ biopsy)

Items under observation:

Preparation of the patient:

  • Established indication for procedure and confirms consent
  • Considers anaesthesia
  • Supervises positioning of patient – correct as required
  • Assembles equipment
  • Chooses appropriate distension medium
  • Demonstrates knowledge of equipment and can troubleshoot problems
  • Knows how to white balance

Operative procedure:

  • Preps and drapes correctly
  • Undertakes preliminary pelvic examination (if under GA)
  • Chooses appropriate instruments (e.g. telescope)
  • Can orientate angled telescope
  • Correct introduction of sheath
  • Systematic approach to viewing entire bladder surface, e.g. trigone, dome, ureteric orifices, urethra
  • Considers 2nd fill where appropriate
  • Determination of cystoscopic bladder capacity (at appropriate pressure)
  • Assessment of whether biopsy required
  • Bladder biopsy performed
  • Correct interpretation of findings, comments on erythema, focal lesion

Mid-urethral tape: retropubic or transobturator approach

Items under observation:

  • Demonstrates awareness of the vascular and neurological anatomy of the vagina, retropubic and obturator spaces
  • Considers antibiotic prophylaxis
  • Considers appropriate anaesthetic technique – should be competent in performing technique under local anaesthetic and sedation as well as regional anaesthesia
  • Ensure suitable positioning, cleaning & draping
  • Institutes and assesses appropriate anaesthetic infiltration and/or considers hydrodissection
  • Can perform safely urethral and when necessary suprapubic catheterization
  • Selects and uses instruments appropriately
  • Appropriate incisions suprapubically and vaginally
  • Considers use of catheter introducer
  • Appropriate technique to insert tape both retropubic and transobturator
  • Appropriate technique for inserting a mid-urethral tape concomitant with a procedure for vaginal prolapse
  • Appropriate response to patient reaction during surgery
  • Undertakes cystourethroscopy appropriately (x 1 or x 2) (knowledge of the different types of cystoscopic equipment available and the appropriate choice and use of instrument)
  • Ability to manage intraoperative complications – haemorrhage, retropubic or vaginal and bladder or vaginal perforation
  • Appropriate adjustment of tape tension
  • Closure of incisions

Posterior repair ± perineorrhaphy

Items under observation:

  • Empty bladder/catheterise when appropriate
  • Consider local anaesthetic infiltration and hydrodissection
  • Selects and uses instruments appropriately
  • Selection of appropriate suture materials and needles
  • Appropriate and adequate dissection
  • Appropriate insertion of fascial plication sutures
  • Management of bleeding (if required)
  • Incision for perineorrhaphy (if required)
  • Building up perineal body (if required)
  • Trim redundant vaginal skin, close vagina and perineum if relevant
  • Assess re need for pack and catheter – consider perioperative laxatives and role of physiotherapy (pelvic floor exercises and defaecatory training)

Vaginal hysterectomy

Items under observation:

  • EUA to assess suitability for vaginal hysterectomy
  • Empty bladder
  • Considers local anaesthetic infiltration and hydrodissection
  • Selects and uses instruments appropriately
  • Selection of appropriate suture materials and needles
  • Appropriate and adequate dissection
  • Appropriate technique to enter Pouch of Douglas
  • Appropriate technique to uterovesical fold
  • Identification, clamping, cutting and ligating of appropriate pedicles
  • Recognition of intra-operative complications and management of bladder, rectal injury or haemorrhage
  • Maintaining adequate haemostasis throughout procedure
  • Ability to assess ovaries and perform bilateral salpingooophorectomy if necessary
  • Plication of uterosacrals and closure of vaginal vault – consider other vault re-suspension techniques
  • Assess need for pack and catheter

Vaginal repair

Items under observation:

  • Correct and full pre-operative consent
  • 1a. Organ damage
  • 1b. Infection
  • 1c. Haemorrhage
  • 1d. Risk of recurrence
  • 2. Cleans and drapes patient appropriately
  • 3. Accurate assessment of degree of prolapse
  • 4. Performs vaginal examination
  • 5. Correct infiltration of vaginal tissue
  • 6. Accurate incision of vagina
  • 7. Correct dissection of vagina from underlying structures
  • 8. Correct choice of vaginal sutures
  • 9. Correct placement technique of any buttress sutures
  • 10. Checks for haemostasis
  • 11. Correct closure of vaginal tissue
  • 12. Insertion of pack and catheter as required
  • 13. Performs rectal examination (posterior repair)

Elsewhere on the site

OSATS
An explanation of OSATS: what they are and how they are used within O&G training
Resources for trainees
Resources to support specialty trainees in O&G