Anatomy of Complications Workshop

The Anatomy of Complications Workshop is a 2 day course. The programme is divided into four discrete but integrated and related modules, each of which is of half a day’s duration. Prior to attending the workshop all participants receive a teaching DVD demonstrating the various procedures to be performed during the practical surgical sessions. They also receive an anatomy CD which is a copy of the material presented at the interactive anatomy lecture during the first module of the workshop. It is crucial that these materials are reviewed by participants prior to attendance at the workshop.

The four modules are:

Anatomy
Surgical Skills
Live Animal Surgery
Case Presentations

Participants work in pairs that are allocated by the workshop organizers. All participants rotate through six different pairings in order to maximize interaction and to allow for the different skill and speed of participants. At the conclusion of the workshop each participant completes a formal structured evaluation questionnaire. This gives valuable feedback to the course organizers and allows for continued improvement in the quality and content of the workshop.


 

 Anatomy

Objectives:

To demonstrate and learn the pelvic surgical anatomy relevant to obstetric and gynaecological surgery.

The anatomical structures which are commonly involved in surgical injury will be reviewed, in particular the major vessels, nerves, ureter and bladder.

The surgical anatomy relevant to urinary incontinence surgery, hysterectomy, ovarian masses and retroperitoneal exploration of the pelvic side wall will be covered.

This session is aimed at revising and improving the participants’ knowledge and understanding of clinically relevant pelvic anatomy.

The first part of this session is an interactive review of pelvic anatomy facilitated by the Directors. Active participation by the learners and all facilitators is encouraged during this review process.

Following the anatomy review  is the practical anatomy session. This includes cadaver dissection and examination of prosected specimens and includes self directed learning materials. The practical anatomy session takes place in the Hill International Surgical Workshop which is next door to the seminar room.

This session requires satisfactory completion of a number of tasks during the cadaver dissection, as outlined below:

  • Dissection of the ureter from the pelvic brim to the bladder.
  • Recognition of the anatomical relationships of the ureter to vessels, muscles, nerves and viscera.
  • Dissection of the vessels of the pelvic side wall, including:
  • Common iliac, external iliac, internal iliac
  • Identification of the branches of the anterior division of internal iliac artery.
  • Dissection of the obturator fossa and contents.
  • Identification of the obturator internus muscle, and the obturator artery , vein and nerve.
  • Identification of the ischial spine, pudendal vessels and levator ani muscle.
  • Dissection of the femoral vein, artery and nerve
  • Dissection of the superior and inferior
  • Dissection of the pararectal and paravesical spaces and the Cave of Retzius.

Surgical Skills

Objectives:

  • To demonstrate, practice and learn the various surgical skills which may be needed to deal with unexpected intraoperative injury to bowel, bladder or ureter.

This session lasts 4 hours and takes place in the Hill International Surgical Workshop at the Clinical Training & Education Centre (CTEC).

Participants work in pairs. After watching a demonstration of the surgical procedures to be learned (as seen on the workshop DVD), each participant then performs and assists at this procedure. We use porcine gut, bladder, ureter and aorta for this practical session.

Polysorb, Caprosyn, Biosyn, and Surgipro sutures are donated to the workshop by Covidien Healthcare.
Double-J (JJ) ureteric stents are donated to the workshop by COOK.

The following procedures are carried out by all the participants under supervision by facilitators:

  • Repair of enterotomy, bowel anastamosis
  • Repair of cystotomy
  • Repair of divided ureter over JJ stent
  • repair of aortic laceration

Live Animal Surgery

Objectives:

  • To demonstrate the pelvic anatomy in the ewe.
  • To confidently dissect the ureter and major pelvic vessels.
  • To repair injury to bowel, perform a bowel reanastamosis, repair injury to the  bladder and to vessels.
  • To practice the technique of internal iliac artery ligation.
  • To raise a colostomy
  • To control haemorrhage from a major vessel using an overlay of autologous tissue (OAT) patch.
  • To be knowledgeable about these procedures and to understand their place in the management of intraoperative injury.

During this session these surgical procedures will be performed by all participants with the supervision of experienced facilitators.

 


 

Case Presentations

Objectives:

  • To present and discuss common clinical situations occurring during and after obstetric and gynaecological surgery.
  • To understand the principles of safe management of injury to bowel, bladder, ureter and major vessels.
  • To understand and learn approaches which lead to a reduction in surgical injury.

This is the final session and is held at Agnes Walsh Lodge in the grounds of King Edward Memorial Hospital for Women in Subiaco.

Prior to attendance, all participants are required to submit one case for presentation. This case  usually describes a surgical or obstetric complication, or a difficult management decision. The presentation is given using  Power Point or equivalent with a maximum of four slides. Each case is allocated 15 minutes to include presentation and discussion. 10 cases will be presented.

This session is facilitated by the directors, and is controlled so that the discussion is constructive and non-threatening. During this session the other participants and facilitators are asked to provide ‘micro- summaries’ of the case under consideration. At the end of each presentation and discussion the group is asked to define the ‘learning points’ from the case. The input of the invited facilitators from other specialties (urology and general surgery) is very valuable and gratefully acknowledged.

This has proved to be a most popular and valuable session; allowing for integration of all the workshop modules.