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Gyn Surgical Curriculum

2006-2007 Gynecologic Morning Report
(Mondays-Fridays, 7 a.m.)

7:00 Scheduled Surgeries

The GYN chief will assign team members to assist with scheduled surgeries the day before the case. Each team member is expected to prepare for the assigned cases by reviewing the relevant anatomy and the procedure in advance. Good sources of information are listed below under Additional Recommended Reading.

Each resident should also be familiar with indications for the procedure, alternative treatments or approaches, potential complications, success and failure rates where appropriate, etc., and be ready to answer questions regarding these topics during the procedure.

7:05 Review of GYN Inpatients

The team should briefly review current inpatients with the service attending. Presentation by students when appropriate is encouraged.

7:15 Surgical Curriculum

A curriculum has been developed to ensure that each resident will cover all aspects of gynecologic surgery determined to be essential both by the GYNS and Urogynecology divisions as well as CREOG. Each resident should read the article(s) assigned for each week that they are on the gynecology rotation (e.g., topics 1 and 2 during the first gyn block, topics 3 and 4 during the second block, and topics 5 and 6 during the last gyn block). He or she should then give a 10-15 minute presentation to the team and service attending during morning report. The chief is responsible for assigning which day each resident will give his or her talk. Friday should be reserved for student presentations.

Additional Recommended Reading

  • An Atlas of Operative Laparoscopy and Hysteroscopy, J Donnez and M Nisolle, The Parthenon Publishing Group.
  • Atlas of Human Anatomy, Frank H Netter, Ciba-Geigy Corporation.
  • Atlas of Pelvic Surgery, Clifford R Wheeless, Williams & Wilkins.
  • Informed Consent in Ethics in Obstetrics and Gynecology, ACOG. 
  • Pelvic Pain Diagnosis and Management, Fred M Howard, Ed, Lippincott Williams & Wilkins.
  • TeLinde’s Operative Gynecology, John A. Rock & Howard W. Jones, III, Eds., Lippincott Williams & Wilkins.
  • Textbook of Gynecology. Larry J Copeland, Ed. WB Saunders Company.

R1

  1. Patient positioning
  • Irvin W, Anderson W, Taylor P, et al. Minimizing the risk of neurologic injury in gynecologic surgery. Obstetrics and Gynecology 2004;103:374-82.
  1. Incisions and suturing       
  • TeLinde’s Operative Gynecology, 9th edition. Pages 237-251 and 255-273.
  1. Endometrial ablation techniques
  • McGurgan P, O’Donovan P.  Endometrial ablation.  Current Opinion in Obstetrics and Gynecology 2003;15:327-332.
  1. Tubal sterilization
  • ACOG Practice Bulletin 2003, Number 46: Benefits and risks of sterilization.
  1. Postoperative pain control
  • Bhavani-Shankar K, Oberoi J. Management of postoperative pain in obstetrics and gynecology. UpToDate 2006.
  1. Postoperative fever
  • de la Torre S, Mandel L, Goff B. Evaluation of postoperative fever: Usefulness and cost-effectiveness of routine workup. American Journal of Obstetrics and Gynecology 2003;188:1642-7.
  • Schey D, Salom E, Papadia A, et al. Extensive fever workup produces low yield in determining infectious etiology. American Journal of Obstetrics and Gynecology 2005;192:1729-34.

R2

  1. Preoperative antibiotics/SBE prophylaxis
  • ACOG Practice Bulletin 2001, Number 23: Antibiotic prophylaxis for gynecologic procedures.
  1. Operative hysteroscopy
  • Falcone T, Gustilo-Ashby A. Minimally invasive surgery for mass lesions. Clinical Obstetrics and Gynecology 2005;48(2):353-60.
  1. Abdominal hysterectomy
  • Baggish M. Total and subtotal abdominal hysterectomy. Best Practice and Research Clinical Obstetrics and Gynaecology 2005;19(3):333-356.
  1. Myomectomy
  • ACOG Practice Bulletin 2000, Number 16: Surgical Alternatives to Hysterectomy in the Management of Leiomyomas. 
  1. Postoperative diet management
  • Pearl M, Frandina M, Mahler L, et al. A randomized controlled trial of a regular diet as the first meal in gynecologic oncology patients undergoing intraabdominal surgery.  Obstetrics and Gynecology 2002;100:230-4.
  1. Bowel injury
  • Pettiti P, Sevin B. Intraoperative injury to the gastrointestinal tract and postoperative gastrointestinal emergencies. Clinical Obstetrics and Gynecology 2002;45(2):492-506.

R3

  1. DVT prophylaxis
  • ACOG Practice Bulletin 2000, Number 21: Prevention of deep vein thrombosis and pulmonary embolism.
  1. Energy sources
  • Klingler C, Remzi M, Marbeger M, et al. Haemostasis in laparoscopy. European Urology 2006 (article in press).
  1. Ectopic pregnancy
  • Seeber B, Barnhart K. Suspected ectopic pregnancy. Obstetrics and Gynecology 2006;107:399-413.
  1. Chronic pain surgery
  • Howard F. The role of laparoscopy in the chronic pelvic pain patient. Clinical Obstetrics and Gynecology 2003;46(4):749-766.
  1. Postoperative electrolyte and fluid management
  • TeLinde’s Operative Gynecology, 9th edition. Pages 173-194.
  1. Hemorrhagic complications
  • Gostout B, Cliby W, Podratz K. Prevention and management of acute intraoperative bleeding. Clinical Obstetrics and Gynecology 2002;45(2):481-91. 

R4

  1. Preoperative management of HTN/Beta Blockers
  • Wesorick D, Eagle K. The preoperative cardiovascular evaluation of the intermediate-risk patient: New data, changing strategies. The American Journal of Medicine 2005;118:1413.e1-1413.e9.
  • Maggio P, Taheri P. Perioperative issues: Myocardial ischemia and protection—beta blockade. Surgical Clinics of North America 2005;85:1091-1102.
  1. Laser
  • TeLinde’s Operative Gynecology, 9th edition. Pages 325-337.
  1. Vaginal hysterectomy
  • Sheth S. Vaginal hysterectomy. Best Practice and Research Clinical Obstetrics and Gynaecology 2005;19(3):307-332.
  1. Laparoscopic hysterectomy
  • ACOG Committee Opinion 2005, Number 311: Appropriate use of laparoscopically assisted vaginal hysterectomy.
  • Claerhout F, Deprest J. Laparoscopic hysterectomy for benign diseases. Best Practice and Research Clinical Obstetrics and Gynaecology 2005;19(3):357-375.
  1. Perioperative care of the geriatric patient
  • Beliveau M, Multach M. Perioperative care for the elderly patient. The Medical Clinics of North America 2003;87:273-289.
  1. Ureteral injury
  • Chan J, Morrow J, Manetta A. Prevention of ureteral injuries in gynecologic surgery.  American Journal of Obstetrics and Gynecology 2003;188:1273-7.
  • Kim J, Moore C, Jones S, et al. Management of ureteral injuries associated with vaginal surgery for pelvic organ prolapse. International Urogynecolgy Journal 2005; DOI 10.1007/s00192-005-0020-7.