Description of the modules Of D.mAS COURSE

Module 1 of Diploma course begins with participation in Fellowship in Minimal Access Surgery course for first two week.

Click here to Learn about Time Table of Initial Two Week F.MAS course.

Time Table Of  LAST TWO WEEK COURSE

(Sunday will differ every month if you want to see exact calendar and minute to minute timetable of your month please click here)

Timetable of exposure in operation theatre varies day to day according to availability of patients

DAY 15
10:00am - 11:00am	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:00pm	Distribution of Project Topic to Diploma Candidates. Distribution of password of various electronic libraries and resources provided by Laparoscopy Hospital.
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	Powerpoint presentation of laparoscopic repair of ventral hernia. Discussion of tricks of performing different methods of ventral hernia including Two port Ventral Hernia and Hernia Surgery without tackers.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04.00pm	Laparoscopic Repair of Hiatus Hernia - Powerpoint Presentation about Laparoscopic Repair of Giant Paraoesophageal hiatus Hernia. Laparoscopy makes it possible to safely and efficiently repair Giant Paraoesophageal hiatus Hernia with an acceptable morbidity. However, this type of operation requires a good training in laparoscopic surgery.
04:00pm - 05.00pm	The Top Gun Laparoscopic Skills and Suturing Program is meant to provide an effective and rapid development platform for skills acquisition and suturing excellence in the videoscopic environment. It proudly patterns itself after a similar training methodology that forms the core curriculum of the Navy’s Top Gun school for fighter pilots. This includes a breakdown of complex tasks to their most elemental level, preparatory drills to facilitate complex task execution, teamwork building, and the use of metrics to evaluate performance.
DAY 16
10:00am - 11:00am	All the Diploma Candidates will be encouraged to increase their skill of laparoscopic suturing by doing Hands On practical of Laparoscopic Suturing on Tissue Every day.
11:00am - 12:00pm	Laparoscopic Myomectomy - Various Methods of Performing Laparoscopic Myomectomy with help of Laparoscopic Suturing Skill. The advantage of this is that patients can go home the same or next day and be back to work in 1-2 weeks. However it is important that the surgery be as complete as by laparotomy or any advantage is lost. Our center has pioneered the technique of highly skilled suturing technique of the muscle by laparoscopic suturing. This creates a strong repair allowing normal VAGINAL delivery even after removing larger intramural fibroids. The use of an electric morcellator to remove the fibroid tissue in long strips has made the surgery speedier so that 18 week size fibroids can be treated in 2 hours.It does not matter whether the fibroids are removed by laser, harmonic scalpel, knife or electrosurgery. The skill of the surgeron is paramount to results.
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	Alternative Methods of Laparoscopic Cholecystectomy - Alternative Methods of Laparoscopic Cholecystectomy like, clipless cholecystectomy, Fundus first cholecystectomy, Partial Cholecystectomy etc...
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04:00pm	Laparoscopic Splenectomy - Laparosocopic splenectomy is a safe procedure if the Surgeon is skilled. As with any other surgical procedure however, complications may occur. The risk of surgery is also related to the disease process for which the splenectomy is being performed. If there is an accessory (extra) spleen and it is not seen during the original laparoscopic procedure, a return to surgery may be necessary to remove it. This Presentation Discuss all the methods of performing Laparoscopic Nephrectomy
03:30pm - 05.00pm	Practice of Surgery of Laparoscopic Myomectomy and laparoscopic Fundopliccation "Hands On Training"
DAY 17
10:00am - 11:00m	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:30pm	Laparoscopic Choledocolithotomy - Powerpoint presentation discussing various laparoscopic methods of performing laparoscopic choledocolithotomy using Dormia basket, Forgaty catheter and Choledocoscope. The laparoscopic choledocolithotomy is considered to be probably the first choice in choledocholithiasis treatment. It is reported on preventing postoperative cholerrhagia and choledochiarctia that, for closing the bile duct, it is important to surely pyle a needle on the whole layer with a margin as small as posssible.
12:30pm - 01:00pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
01:00pm - 02:00pm	Laparoscopic management of Stress Incontinence - Powerpoint presentation discussing the Burch procedure which requires the elevation of the anterior wall of the vagina to the level of the origin of the paravaginal fascia by suspension from Cooper’s ligaments (iliopectineal ligaments). A properly performed Burch procedure cures 93 percent.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04.00pm	Thoracoscopic Sympathectomy - Endoscopic sympathectomy is a highly-effective treatment for patients with palmar or facial hyperhydrosis. ETS allows simultaneous treatment of both sides with a very low risk of complications. Attention to surgical detail is important to achieve excellent long-term results.
04:00pm - 05.00pm	Practice of Surgery of Burch Suspension and Choledocolithotomy Hands On technique
DAY 18
10:00am - 02:00pm	Practice on Live Tissue in operation theatre environment for the participants according to individual choice of every Gynaecologysts, General Surgeon and Urologists. They will be able to perform during Diploma course dissection of Laparoscopic Hernia Surgery, Laparoscopic Nephrectomy, Laparoscopic Total Hysterectomy, Laparoscopic Burch suspension, Laparoscopic Varicocelectomy, Laparoscopic myomectomy, Laparoscopic Cystectomy, Laparoscopic Pyeloplasty, Laparoscopic Fundoplication, Laparoscopic Gastric Banding, Laparoscopic Repair of Duodenal Perforation, Laparoscopic Colorectal Surgery, Laparoscopic Radical Hysterectomy, Laparoscopic Lymphadenectomy, Laparoscopic Adrenelectomy etc. They will repeat the cholecystectomy, hernia, Appendicectomy, tubal and Ovarian Surgery or any laparoscopic surgery of your choice.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04:00pm	Discussion abouts dissection problems and How to correct it?
04:00pm - 05.00pm	Discussion of project of all the candidates and Submission of Abstract

DAY 19
10:00am - 11:00am	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:00pm	Laparoscopic Management of Hydatid Cyst - We describe the laparoscopic excision of a hydatid cyst in the liver. During the procedure, done after treatment with the scolicidal agents praziquantel and albendazole, care was taken to prevent spillage of scolices during evacuation of contents and to excise the entire germinal epithelium. The patient had no immediate or short-term complications and is asymptomatic 3 months later.
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	Laparoscopic Nephrectomy - Technique of Performing Laparoscopic Nephrectomy - Three or four small abdominal incisions are made in the abdomen to provide access for surgical instruments that are used to detach the kidney and to ligate the blood vessels. The intact kidney is enclosed in a bag and removed through an incision or it may be placed in an impermeable sack, morcellated and removed through one of the port sites.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04.00pm	Laparoscopic management of Vesico Vaginal Fistula - Powerpoint presentation discussing how to repair VVF. We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity.
04:00pm - 05.00pm	The Top Gun Laparoscopic Skills and Suturing Program is meant to provide an effective and rapid development platform for skills acquisition and suturing excellence in the videoscopic environment. It proudly patterns itself after a similar training methodology that forms the core curriculum of the Navy’s Top Gun school for fighter pilots. This includes a breakdown of complex tasks to their most elemental level, preparatory drills to facilitate complex task execution, teamwork building, and the use of metrics to evaluate performance.
DAY 20
10:00am - 11:00am	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:00pm	Laparoscopic Repair of Duodenal Perforation - Our result have shown that the laparoscopic surgery may become the gold standard for surgical treatment of complicated peptic ulcer disease. Laparoscopic closure of duodenal ulcer perforation is an attractive alternative to conventional surgery with the benefits of minimally invasive surgery such as parietal wall integrity cosmetic benefits and early subjective post operative comfort and rehabilitation.
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	How to Perform TVT and TOT - The introduction of TVT sling procedures in the mid-1990s rapidly took hold worldwide as a simple, minimally invasive alternative to open or laparoscopic Burch colposuspension. They are now the most widely performed procedures in the United States for stress urinary incontinence.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04.00pm	Laparoscopic Gastrectomy - Gastrectomy, either total or subtotal (also called partial), is the treatment of choice for gastric adenocarcinomas, primary gastric lymphomas (originating in the stomach), and the rare leiomyosarcomas (also called gastric sarcomas). Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas, for which gastrectomy offers good odds for survival.
04:00pm - 05.00pm	Hands On Training of Repair of Duodenal Perforation and TVT and TOT for Gynaecologists and Urologists
DAY 21 SUNDAY HOLIDAY (Sunday will differ every month if you want to see exact calendar and minute to minute timetable of your month please click here)
DAY 22
10:00am - 02:00pm	Practice on Live Tissue in operation theatre environment for the participants according to individual choice of every Gynaecologysts, General Surgeon and Urologists. They will be able to perform during Diploma course dissection of Laparoscopic Hernia Surgery, Laparoscopic Nephrectomy, Laparoscopic Total Hysterectomy, Laparoscopic Burch suspension, Laparoscopic Varicocelectomy, Laparoscopic myomectomy, Laparoscopic Cystectomy, Laparoscopic Pyeloplasty, Laparoscopic Fundoplication, Laparoscopic Gastric Banding, Laparoscopic Repair of Duodenal Perforation, Laparoscopic Colorectal Surgery, Laparoscopic Radical Hysterectomy, Laparoscopic Lymphadenectomy, Laparoscopic Adrenelectomy etc. They will repeat the cholecystectomy, hernia, Appendicectomy, tubal and Ovarian Surgery or any laparoscopic surgery of your choice.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04:00pm	Discussion abouts dissection problems and How to correct it?
04:00pm - 05.00pm	Discussion of project of all the candidates
DAY 23
10:00am - 11:00am	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:00pm	Thoracoscopic Procedures - Since Jacobaeus performed the first thoracoscopy to explore pleural space and mechanically broke pleural adhesions to facilitate the collapse therapy for pulmonary tuberculosis in 1910, numerous thoracic surgeons have been attempting this technique as a means of accomplishing many intrathoracic procedures previously done through open thoracotomy. As the refinement of video technology has advanced, thoracoscopic surgery has played a very important role in thoracic surgery especially since the early 1990s. This powerpoint Presentation of various thoracoscopic procedures like sympathectomy, bullectomy, oesophagestomy, lobectomy etc...
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	Laparoscopic Management of Genitourinary Prolapse - The description of the laparoscopic treatment of genitourinary prolapse covers all aspects of the surgical procedure used for the management of genital prolapse. Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exposure, dissection, posterior prosthesis, closure, promontory, vesico-vaginal dissection, anterior mesh, promontory fixation, repair of peritoneum, drainage/closure. Consequently, this operating technique is well standardized for the management of this condition.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04.00pm	Laparoscopic Gastric Banding
04:00pm - 05.00pm	The Top Gun Laparoscopic Skills and Suturing Program is meant to provide an effective and rapid development platform for skills acquisition and suturing excellence in the videoscopic environment. It proudly patterns itself after a similar training methodology that forms the core curriculum of the Navy’s Top Gun school for fighter pilots. This includes a breakdown of complex tasks to their most elemental level, preparatory drills to facilitate complex task execution, teamwork building, and the use of metrics to evaluate performance.
DAY 24
10:00am - 11:00am	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:00pm	Laparoscopic Low Anterior Resection - Procedures that involve resection of the distal rectum challenge the current limitations of laparoscopic technology, because of lack of compact articulating stapling instruments. We improve the procedure with the aid of a Lap disk, an abdominal wall sealing device that was developed for hand-assisted manipulation. A linear stapler capable of changing its stop angle is inserted through the disk, and the rectum is transected by the disk during a second pneumoperitoneum. The transection line becomes equivalent to that obtained with laparotomy. This new technique made laparoscopic lower anterior resection possible to transect the lower rectum in the same way as is done with laparotomy.
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	Laparoscopic Radical Hysterectomy - This presentation demonstrates total laparoscopic radical hysterectomy with bilateral pelvic lymphadenectomy using a different energy sourses for dissection of pelvic spaces and unroofing the ureter.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04.00pm	Procedures for Prolapse and Haemorroids - The PROXIMATE HCS Procedure for Prolapse and Hemorrhoids (PPH) Set delivers two staggered rows of titanium staples in 33mm diameter size. The instrument has application in the anal canal for transection and resection of internal tissues as an alternative approach to the surgical treatment of hemorrhoidal disease. The PPH01 set of instruments includes a 33mm Hemorrhoidal Circular Stapler, Suture Threader, Circular Anal Dilator and Purse-string Suture Anoscope.
04:00pm - 05.00pm	Complication of Laparoscopic Cholecystectomy
DAY 25
10:00am - 02:00pm	Practice on Live Tissue in operation theatre environment for the participants according to individual choice of every Gynaecologysts, General Surgeon and Urologists. They will be able to perform during Diploma course dissection of Laparoscopic Hernia Surgery, Laparoscopic Nephrectomy, Laparoscopic Total Hysterectomy, Laparoscopic Burch suspension, Laparoscopic Varicocelectomy, Laparoscopic myomectomy, Laparoscopic Cystectomy, Laparoscopic Pyeloplasty, Laparoscopic Fundoplication, Laparoscopic Gastric Banding, Laparoscopic Repair of Duodenal Perforation, Laparoscopic Colorectal Surgery, Laparoscopic Radical Hysterectomy, Laparoscopic Lymphadenectomy, Laparoscopic Adrenelectomy etc. They will repeat the cholecystectomy, hernia, Appendicectomy, tubal and Ovarian Surgery or any laparoscopic surgery of your choice.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
03:00pm - 04:00pm	Discussion abouts dissection problems and How to correct it?
04:00pm - 05.00pm	Final Submission of Project towards D.MAS
DAY 26
10:00am - 11:00am	Laparoscopic Hands On Suturing Practice over Live Tissue
11:00am - 12:00pm	Laparoscopic Rectopexy - Powerpoint presentation about Laparoscopic management of Rectal Prolapse? Laparoscopic rectopexy is a technically feasible method, which resulted in improved continence in the majority of our patients. This was associated with a significant increase in continence grade in our patients without important worsening of constipation’s rate. Anorectal function study demonstrated a (partial) recovery of the internal anal sphincter. Moreover, laparoscopic rectopexy combines the low morbidity of minimally invasive surgery with the good clinical outcome of abdominal rectopexy.
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 02:00pm	Robotic Surgery Present Past and Future - Robotic surgery is the use of robots in performing surgery. Three major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Major potential advantages of robotic surgery are precision and miniaturization. Further advantages are articulation beyond normal manipulation and three-dimensional magnification.
02:00pm - 03:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
05:00pm - 05.00pm	Advancement in Minimal Access Surgery - Demonstration of advanced laparoscopic instruments in commercial institutes like Ethicon, Storz, Olympus, Wolf. Tour program organized by Laparoscopy Hospital
DAY 27
10:00am - 12:00pm	Examination (Essay type questions will be asked. Pass Marks is 50%. Each Question carries equal marks).
12:00pm - 12:30pm	Refreshment (Snacks, Tea, Coffee or Cold drink will be provided by Institute)
12:30pm - 01:30pm	TEM - Transrectal endoscopic microsurgery is a procedure introduced in Germany in the beginning of the 80-decade. Its application in the resection of recto sigmoideal lesions is accepted every day with more enthusiasm. The adenoma is a frequent disease and the utilization of this procedure for the local treatment of the tumor offers great benefits and excellent results. By using a 40 mm wide and 20 cm long operating resctoscope sealed with a gastight working insert to prevent pressure loss after creation of a pneumorectum and a stereoscopic optic, exact visualization of a rectal tumor can be achieved. The insertion of endoscopic surgical instruments like the high frequency knife, forceps, scissors and suction device allows precise excision of the lesion as well as suture closure of the wound. In this work I report the experience with 32 patients suffering rectal villous adenoma and treated by transrectal endoscopic microsurgery, TEM.
01:30pm - 02:00pm	Methods of Laparoscopic Documentation for Medicolegal Cases
01:30pm - 02:00pm	Lunch (Working Lunch will be provided in Resourse and Dinning area of Institute)
02:00pm - 03.00pm	Open session is For Question and Answer about any Laparoscopic Procedures. During This Open session candidate can ask anything related to Minimal access Surgery from Prof. Dr. R.K. Mishra.
DAY 28 SUNDAY HOLIDAY (Sunday will differ every month if you want to see exact calendar and minute to minute timetable of your month please click here)

THE TOPICS COVERED IN D.MAS WHICH IS NOT TOUGHT IN F.MAS

For General Surgeon and Gynaecologist:

• Top Gun Drill Exercises to develop suturing skill
• Bipolar Monopolar Exercises
• Bowel Anastomosis Exercises
• TVT, and TOT Practices
• Endoscopic Reserction Exercises (TURP, Hysteroscopy)

For Surgeons:

• Laparoscopic Gastric Bypass
• Laparoscopic Retroperitoneoscopy
• Laparoscopic Sygmoidectomy
• Laparoscopic Anterior Resection
• Laparoscopic Gastrectomy
• Laparoscopic Rectopexy
• Thoracoscopic Oesophageal Myotomy
• Thoracoscopic Sympathectomy
• Axilloscopy
• Notes (Principles only)
• Robotics (Principles only)

For Gynaecologist:

• Laparoscopic Radical Hysterectomy
• Laparoscopic Lymphadenectomy
• Laparoscopic Sacrocolpopexy
• Laparoscopic Management of Complicated Endometriosis
• TVT
• TOT
• Pelvic Floor Reconstruction
• Notes (Principles only)
• Robotics (Principles only)

Training of Medical Video Editing
The digital age has caused a significant impact on the medical field and together with the advent of minimally invasive techniques, having digital documentation has improved the standard of clinical presentations, teaching, and congress lectures. Video Editing is a skill that surgeons must possess to properly document his personal cases and more importantly to share with colleagues a clearer and more comprehensible picture of the procedures performed in a peer-review setting. Likewise, properly edited video presentations are gaining more popularity in international meetings where vivid images displaying actual surgical techniques and styles can be easily conveyed to the audience. Video presentations are even preferred by a growing number of surgeons over plain lecture conferences. At the completion of the course, participants will be familiar with the various video formats and file types from AVI to MPEG to MXF and be able to import them to preferred editing software. Add sounds and music, labels, simultaneous picture-in-picture clips to your videos. Furthermore, you will be able to acquire digital images from most common sources, manipulate video material into a respectable and presentable multi-media product.

Module 2: Clinical attachment

The spectrum of clinical observation is not restricted to the observation of surgical procedures, but  includes out-patient and ward based activities, to facilitate understanding of presentation, diagnosis, selection, consent and outcome related to safe  minimal access surgery. The student is  exposed to a wide range of MINIMAL ACCESS SURGERY including laparoscopic, thoracoscopic and endoluminal procedures. This  include sessions undertaken by other specialties also.

 

Candidates will be able to observe minimal access surgery on a regular basis. This would be also facilitated by utilizing the theatre link for regular observation which will be timetabled and supervised. Encouragement will be given to allow them to observe minimal access techniques in other specialties, particularly where this would add to their knowledge and understanding. 

 

Module 3: Literature review

 

 

One of the first tasks to be completed is a literature review of a subject of the participants choice. This is designed to:

1. Test information retrieval skills

2. Test skills of critical analysis

3. Test presentation skills

4. Test use of English

5. Provide detailed knowledge of a topic relevant to MINIMAL ACCESS SURGERY

The subject for review should be relevant to MINIMAL ACCESS SURGERY, and will be selected by the individual student at the start of the course. Guidance will be given to those who are uncertain as to their choice.  A preliminary literature search will form part of the research methodology module. Peer group presentations will take place in the third week of the term, and a draft write up completed by fourth week. Literature reviews will be archived in Laparoscopy Hospital and will be available on the Department internet.

 

Project Topic

 

Each Students is invited to submit a proposal for their project at the start of the course. The initial project description  takes place within one weeks of the start of the session with a further 2 week period is allowed to develop and refine their chosen topic.

 

The proposal should be:

1. Relevant to MINIMAL ACCESS SURGERY

2. Original

3. Achievable within constraints of scope, time, finance and publishable in peer review journal

In the event of the student not being able to formulate a satisfactory project, a choice of potential topics will be offered. It is paramount that the student and supervisor meet regularly to discuss direction and progress and to avoid difficulty and ensure completion within an appropriate length of time. In addition, students will be expected to present their progress periodically throughout the session.

 

A prize will be awarded each year, for the best literature review published.

 

Module 4 A: Ergonomics of Minimal Access Surgery

 

Content

1. General principals of ergonomics

2. Task analysis

3. Objective assessment of task performance

4. Limitations in minimal access surgery

5. Ergonomics of theatre & endoscopic set-up

6. Ergonomic principals of instrument design

7. Ergonomic principals of tissue dissection

8. Ergonomic principals of intracorporeal knot tying and bowel suturing tissue retrieval

9. Laparoscopic assisted surgery

10. Analysis of surgeon's movement during minimal access surgery

11. Impact of technology on practice in minimal access surgery

12. Assessment of psychomotor skills in minimal access surgery

 

Objectives

 

On completion of this module the student should be able to:

1. Apply the established principles of ergonomics to theatre set up and instrument placement in practical situations

2. Demonstrate an understanding of the effect of the laparoscopic approach on the surgeon's movements and performance                                                                    .

3. Carry out a task analysis and assess endoscopic performance

4. Assess the impact of new technology or instrumentation on surgical practice

5. Appreciate what strategies need to be applied during the introduction of new technology

Module 4 B: Risk Assessment, Accident Prevention, Ethical and Legal Implications for Laparoscopic Surgery Surgery.

 

Content

 

The nature and estimation of risk. Human performance and perception of risk. Assessing risk and minimising risk. Error rates. The 'incident pit'. Health and Safety. First time accuracy. Informed consent. Appropriate responses when problems or complaints occur. Communications. Negligence. The impact of co-workers.

 

Objectives

 

On completion of this module the student should be able to:

1. Assess risk and communicate this assessment               .

2. Design systems to minimize hazards

3. Understand the impact of human psychology on risk perception.,  taking precaution etc.

 

Teaching Methods

 

Tutorials and directed reading

 

Module 4C: Instrument design

 

 

Content

 

1. The design process of Instrument in Minimal Access Surgery

2. Initial research, and identification of functional requirements, Prototype modeling and refinement

3. The stages of prototype assessment of Laparoscopic Instruments

4. Relationships with Laparoscopic Instrument industry

5. Instrument manufacturing procedure

6. Instrument care and sterilization

 

Objectives

 

Knowledge of the function of the instrument technology behind Minimal Access Surgery.

 

 

Module5 : Teaching Skill and Practical Skill Acquisition

 

In this module the participants will be encouraged to participate as instructor in  F.MAS (Fellowship in Minimal Access Surgery) during the Four Week D.MAS Course. The Purpose of this module is to improve the teaching skill of Participants. There will be regular supervised practical skills training sessions, encompassing all of the practical elements of the Basic and Advanced Laparoscopic Skills. Additional material will be provided, directed by student requests.

1. Whenever possible there will be the opportunity for further (unsupervised) practice.

2. Skills will be taught and learnt in a logical sequence, and will be revised and consolidated.

3. Each component skill will be taught in a manner to emphasis risk management.

 

Module 6: Laparoscopic Vision Technology

 

Content

 

Review of the physiology of stereoscopic vision. Introduction to visual psychology. Differences between the visual processing of real images, pictures and other planar representations. Perceptions of colour, brightness, space, Monocular depth clues. Parallax. The Vistral Effect. History of endoscopic imaging. Principles of rigid and fibreoptic endoscopes. Today's endoscopic visual system and its component elements - variety of telescopes, camera technology, light source and image display. Optical assessment of video­endoscopes. Video and computer generated images. Video formats. Digitization. Types of endoscopic display system 2D and 3D current visual technology and the future of this technology e.g. suspended image. Use of computer tomography, magnetic resonance imaging and intra-operative ultrasound.

 

Objectives

 

On completion of this module the student should be able to:

1. Demonstrate an understanding of human visual physiology and psychology

2. Appreciate the effects of indirect viewing on perception and performance

3. Appreciate the effects of 2 and 3 D images on perception and performance

4. Use a range of endoscopic visual systems effectively and efficiently

5. Understand the technical features of current endoscopic viewing systems

6. Capture images for future use and understand their requirements for presentation

 Module 7a: Tissue

 

Pathophysiology of methods of access, and intervention in minimal access surgery, including ligation and tissue approximation.

 

Contents

 

1. Access Techniques

2. Pneumoperitoneum (Insufflation techniques, Insufflation of gases, Insufflation volume and rate, Intra-abdominal pressure)

3. Patient positioning. Potential complications - cardiac performance during MINIMAL ACCESS SURGERY,

4. Homodynamic alterations with pneumoperitoneum, effects, other systemic complications. Inflammatory and metabolic response to MINIMAL ACCESS SURGERY vs. Open surgery.

5. Alternatives to pneumoperitoneum. Anesthetic management during endoscopy (laparoscopy and thoracoscopy) including position, monitoring, anesthetic techniques, pain control.

6. Tissue Ligation and Approximation

7. Sutures and suture materials - history, basic principles, knots, suture characteristics, effects of ligation, the physics of ligation. Endoscopic ligation. Nonabsorbable clips. Absorbable clips. Ligation devices (Stapling and stapling devices: historical development, principles, equipment, advantages and disadvantages). Endoscopic suturing: various techniques.

Objectives

 

On completion of this module the student should be able to:

1. Insert a Veress needle with appropriate technique and set up and operate an insufflator .

2. Perform various techniques for creating a pneumoperitoneum and discuss their advantages and disadvantages.

3. Describe the haemodynamic and other changes associated with a pneumoperitoneum and the effects of pressure, flow rate, volume, and the nature of gas used           .

4. Discuss the alternatives to pneumoperitoneum and the design of associated systems.

5. Effect of pneumoperitoneum or thoracoscopy on anaesthetic management