Skip to main content

OSATS, urogynaecology

This page sets out the OSATS requirements for subspecialty training in urogynaecology.

You have to be competent in:

Colposuspension

Items under observation:

  • Obtain appropriate consent
  • Correct use of antibiotics
  • Patient positioned correctly on the operating table
  • Clean and drape correctly
  • Patient catheterised throughout
  • Correct incisions
  • Open retropubic space
  • Identify bladder neck
  • Mobilise bladder neck from vagina
  • Visualise ileopectineal ligament
  • Appropriate choice and placement of sutures
  • Sutures tied with appropriate tension
  • Drain retropubic space, if appropriate
  • Appropriate closure of wounds
  • Drain bladder appropriately
  • Cystoscopy intraoperatively, as appropriate

Cystoscopy

Items under observation:

  • Obtain appropriate consent
  • Clean and drape correctly
  • Choose correct scope
  • Assemble scope correctly
  • Visualise whole bladder
  • Identify ureteric orifices
  • Observe the urethra
  • Appropriate use of antibiotics
  • Empty bladder at end of procedure

Midurethral sling

Items under observation:

  • Obtain appropriate consent
  • Correct use of antibiotics
  • Patient positioned correctly on the operating table
  • Clean and drape correctly
  • Choose appropriate tape
  • Catheterise throughout the operation
  • Appropriate infiltration
  • Appropriate vaginal incision
  • Appropriate dissection
  • Identify exit points and incise skin, as appropriate
  • Pass needles correctly
  • Adjust tension correctly
  • Repair incisions
  • Carry out intraoperative cystoscopy with 700 scope as appropriate for the procedure

Posterior repair

Items under observation:

  • Obtain appropriate consent
  • Correct use of antibiotics
  • Patient positioned correctly on the operating table
  • Clean and drape correctly
  • Assess prolapse under anaesthesia
  • Appropriate infiltration
  • Appropriate vaginal incision
  • Mobilise the rectum
  • Insert appropriate supporting sutures
  • Excise appropriately excess vaginal tissue
  • Drainage of bladder, as appropriate
  • Pack inserted, as appropriate
  • Intraoperative rectal examination, as appropriate

Sacrocolpopexy

Items under observation:

  • Obtain appropriate consent
  • Correct use of antibiotics
  • Patient positioned correctly on the operating table
  • Clean and drape correctly
  • Patient catheterised throughout
  • Correct incisions
  • Deal with adhesions, as necessary
  • Identify ureters
  • Identify vaginal vault, bladder and rectum
  • Reflect peritoneum off the vault/bladder/rectum, as appropriate
  • Open peritoneum over promontory
  • Choose appropriate mesh and suture for operation
  • Attach mesh to vagina and promontory appropriately with correct tension
  • Bury mesh, as appropriate
  • Drain, if appropriate
  • Close incisions correctly
  • Drain bladder appropriately

Sacrospinous fixation

Items under observation:

  • Obtain appropriate consent
  • Correct use of antibiotics
  • Patient positioned correctly on the operating table
  • Clean and drape correctly
  • Assess prolapse under anaesthesia
  • Appropriate infiltration
  • Appropriate vaginal incision
  • Mobilise the rectum
  • Open the pararectal space to identify sacrospinous ligament
  • Place suture through ligament
  • Check correct hold of suture
  • Attach sutures to vault
  • Excise appropriate excess tissue
  • Posterior repair, as required
  • Close vagina
  • Pack and catheter, as appropriate

Urodynamics

Items under observation:

  • Checks for UTI test results
  • Gives antibiotics as appropriate
  • Obtains appropriate consent
  • Is able to set up machine and check calibration
  • Obtains free flow at start of test
  • Cleans external urethral meatus
  • Inserts bladder line and catheter appropriately
  • Checks urinary residual
  • Vaginal examination as appropriate
  • Inserts rectal line
  • Balances pressure lines
  • Performs filling cytometry
  • Undertakes appropriate provocation tests
  • Appropriate stress testing
  • Obtains pressure/voiding trace
  • Removes lines
  • Obtains post-test residual

Vaginal hysterectomy and anterior repair

Items under observation:

  • Obtain appropriate consent
  • Correct use of antibiotics
  • Patient positioned correctly on the operating table
  • Clean and drape correctly
  • Assess prolapse under anaesthesia
  • Appropriate infiltration
  • Appropriate vaginal incision
  • Mobilise the bladder
  • Enter pouch of Douglas correctly
  • Clamp, divide and ligate pedicles, as appropriate
  • Check for haemostasis
  • Close vault and peritoneum, as appropriate
  • Incorporate adequate vaginal vault support
  • Insert appropriate bladder supporting sutures
  • Excise excess tissue correctly
  • Close anterior vaginal wall
  • Drainage of bladder, as appropriate
  • Insert pack, as appropriate

Laparoscopic sacrocolpopexy 

This OSATS is only applicable to those undertaking the optional module in laparoscopic urogynaecology.

Items under observation:

  • Ensures correct positioning of the patient, catheterisation throughout and insertion of the uterine manipulator
  • Assess patient habitus
  • Correct use of antibiotics
  • Safe use of Veress needle (if used)
  • Safe insertion of primary port
  • Appropriate position of and safe insertion of secondary ports
  • Maintains good view of the operative field
  • Uses appropriate instruments for the task
  • Knowledge and safe use of energy modalities in laparoscopic surgery
  • Identifies important anatomical structures on pelvic side wall (ureter, internal iliac artery/vein) and within broad ligament
  • Identifies pelvic structures as appropriate
  • Open peritoneum over promontory and over rectum and bladder as appropriate
  • Open peritoneum over pelvic side wall
  • Choose appropriate mesh and suture for operation
  • Attach mesh to vagina and promontory appropriately with correct tension
  • Bury mesh, as appropriate
  • Drain if appropriate
  • Drain bladder appropriately
  • Remove ports and close incisions appropriately
  • Shows efficiency of movement and demonstrates good three-dimensional spatial awareness
  • Appropriate use of assistants

Laparoscopic sacrohysteropexy 

This OSATS is only applicable to those undertaking the optional module in laparoscopic urogynaecology.

Items under observation:

  • Ensures correct positioning of the patient, catheterisation throughout and insertion of the uterine manipulator
  • Assess patient habitus
  • Correct use of antibiotics
  • Safe use of Veress needle (if used)
  • Safe insertion of primary port
  • Appropriate position of and safe insertion of secondary ports
  • Maintains good view of the operative field
  • Uses appropriate instruments for the task
  • Knowledge and safe use of energy modalities in laparoscopic surgery
  • Identifies important anatomical structures on pelvic side wall (ureter, internal iliac artery/vein) and within broad ligament
  • Identifies pelvic structures as appropriate
  • Open peritoneum over promontory and around uterus as appropriate
  • Open peritoneum over pelvic side wall
  • Choose appropriate mesh and suture for operation
  • Attach mesh to uterus and promontory appropriately with correct tension
  • Bury mesh, as appropriate
  • Drain if appropriate
  • Drain bladder appropriately
  • Remove ports and close incisions appropriately
  • Shows efficiency of movement and demonstrates good three-dimensional spatial awareness
  • Appropriate use of assistants

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