Course organised in Birmingham, UK by Dr Ayman Ewies

1. COURSE ORGANIZER
MR AYMAN EWIES
CONSULTANT GYNAECOLOGIST
17-19 NOVEMBER 2015
Course Briefing
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1Course Organiser: Mr Ayman Ewies
Consultant Gynaecologist, MBChB, MSc, FRCOG, MD
17th – 19th November, 2015
Birmingham City Hospital
the second annual
advanced
hysteroscopic
surgery
workshop

2. Hysteroscopy
o Hysteroscopy is the gold standard for investigating the
uterine cavity.
- previously evaluated with blind and inaccurate technique; D&C!
o Hysteroscopy allows direct visualisation of the uterine
cavity with the opportunity for targeted biopsy, safe
removal of polyps/fibroids and treatment of adhesions.
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Hysteroscopy

4. o Hysteroscopy is generally safe and efficient.
o Further, the procedure can be performed on an outpatient or day-case
basis:
-Cost effective for the NHS
-Convenient to patients
o Nonetheless; advanced hysteroscopic surgical procedures are minimally
invasive procedures, which have a slow learning curve and a narrow
margin for error.
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Hysteroscopy

5. o The complication rate is low even with operative
hysteroscopy; however, the procedure can be life-
threatening in rare cases.
o The keys for the safe and efficient utilisation of this tool:
1. Appropriate training
2. Understanding the technique, equipment, troubleshooting and
indications
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Hysteroscopy

6. RCOG classification of operative hysteroscopy levels
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 Level 1
√ Diagnostic hysteroscopy with target biopsy
√ Removal of simple polyps
√ Removal of intrauterine contraceptive device
 Level 2
√ Proximal fallopian tube cannulation
√ Minor Asherman's syndrome
√ Removal of pedunculated fibroid (type 0) or large polyp
 Level 3
√ Division/resection of uterine septum
√ Major Asherman's syndrome
√ Endometrial resection or ablation
√ Resection of submucous fibroid (type 1 or type 2)
√ Repeat endometrial ablation or resection

7. o Traditionally, surgical training in hysteroscopy takes place
in the operating room where trainees first observe the
procedure performed and then take on increasing roles in
surgical cases under direct supervision.
o In recent years, due to reduced training opportunities, the
major shift in surgical training is towards the use of
simulation and animal laboratories.
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Why is this workshop?

8. Advantages of Visual Reality Simulator and Animal
Laboratory Models
1. They complement conventional surgical training, aiming to
maximise clinical exposure and minimise patients’ harm.
2. They help develop eye-hand-foot coordination and
manual dexterity skills that enable competent
performance of procedures in a shorter operating time.
3. They allow the opportunity for repeated practice, feedback,
and ability to learn without causing harm.
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Why is this workshop?

9. o As early as 1927, Mayo, one of the founders of the renowned Mayo
Clinic, argued that “there is no excuse for the surgeon to learn on
the patients” .
o The logical sequence of events is that one has to crawl before
he/she can walk; therefore, skills need to be practiced thoroughly
before one contemplates doing them on patients. .
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Why is this workshop?

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1. To achieve advanced level competency (RCOG level 3)
which equate to being able to perform endometrial
ablation using resection technique.
2. To focus on the safety aspect of advanced hysteroscopic
surgery.
The Aims of the Course

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Knowledge criteria:
1) Knowledge of instruments.
2) Understand the principles of safe use of energy sources and distension media.
3) Understand the indications and technique of operative hysteroscopy.
4) Be familiar with the main hysteroscopic procedures including:
-TCRE/TCRP/TCRF
-Morcellation (Myosure)
-Second generation non-hysteroscopic endometrial ablation
-Essure hysteroscopic sterilization
5) Awareness of methods of endometrial preparations.
6) Understand the current use and future development of ambulatory hysteroscopy.
7) Awareness of potential complications and ways to prevent and manage them.
Learning Objectives

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o ½ Day of lectures.
o 3 x ½ Days of hands-on practice – 9 stations:
1. Myosure: Visual Reality Simulator + Polly Trainer
2. Essure: Visual Reality Simulator
3. TCRE/TCRP/TCRF/Resection Septum: HystSim Visual Reality
Simulator
4. TCRE: Olympus Potato Model
5. TCRE/Septum Resection: City Cattle Uterus Model
6. TCRE: Ethicon Plastic Uterus Model
7. Versapoint Polypectomy: Ethicon Pig Bladder Model
8. Poly Snare Polypectomy: Pepper Model (& Williams Needle)
9. Second generation ablation: Thermachoice (Clover model
Demonstration) + Novasure + Thermabate
Course Briefing

13. RCOG Requirements for The ATSM of Hysteroscopy
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RCOG Requirements for The ATSM of Hysteroscopy

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o 1st and 2nd generation ablation.
o Hysteroscopic Polypectomy.
o Resecting SMF grade 0-2.
o Resecting intrauterine adhesions.
o Resecting uterine septum.
+
o Outpatient ablation.
o Hysteroscopic sterilization.
RCOG Requirements for The ATSM of Hysteroscopy
Do
Observe

16. Sponsors
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17. Sponsors
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1. Mr Ayman Ewies, Consultant Gynaecologist.
2. Mr Joe Kabukoba, Consultant Gynaecologist.
3. Miss Olufunmilola Ajibona, Consultant O+G.
4. Dr Zahid Khan, Specialty Trainee in O+G.
5. Mr Jim Ng, Senior Theatre Nurse.
6. Sister Sara Greenaway, Nurse Hysteroscopist.
Faculty

19. Expectations
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oName
oPosition
oPlace of Work
oExpectations