Current status of training in hysteroscopy The European perspective Y. Van Belle Helsinki, September 21th 2016
Hysteroscopy 20th century • A difficult technique • Very slow learning curve • Organ-specific and technique- specific problems
Hysteroscopy 20th century - issues Technique-specific Organ-specific • Optical systems • Virtual cavity • Size instruments • Thick muscular wall • Distension media • Fragile endometrium
Hysteroscopy 20th century II Gynaecologists, scientists & engineers • Miniaturization instruments & telescopes • Atraumatic insertion technique • Improvement of optical features • Digital processing of images • Multimedia archiving & transmission
Hysteroscopy 21th century Simple, safe and efficient technique BUT • Very poor spread in daily practice • Not part of conventional medical training • Hence need for postgraduate teaching
Training in Hysteroscopy The global protocol • Theoretical teaching : Computer screen or blackboard ? Multimedia as perfect compromise ? • Hands - on training : Synthetic, animal or human models ? Virtual reality training ? • Clinical teaching : Telesurgery : sense or nonsense ? The “expert on your side” training : just wishful thinking ?
Training in Hysteroscopy conclusions 2003 • Outstanding technique In order to let the patient exists benefit from the • Traditional medical remarkable technical training fails progression in the last • International Societies’ decades, the International responsability Societies should, in close collaboration with the industry, offer to each gynaecologist the possibility of standardized training in hysteroscopy.
Gynaecological Endoscopic Surgical Education and Assessment GESEA Programme
Practical test to measure the competence level of an individual in basic hysteroscopic psychomotor skills like camera handling, hand-eye coordination and bi-manual handling in the specific uterine environment.
� 2 Exercises: - Camera Navigation: evaluates the skills to handle the camera and work with a 30 ° optic - Hand-eye coordinate evaluates the skills of simultaneous camera and instrument handling. � Scoring: Time to Correct Performed Exercise � Assistant/Mentor responsible for time registration and scoring form
� All exercise runs are carried out & timed simultaneously under instruction of the head mentor � Each exercise is done 3 times � Exercises are done in PAIRS � Change the participant after each run
Ex 1: Camera Navigation AIM to evaluate the participant’s ability to navigate the hysteroscope, using forward/backward and rotation movements, in order to be able to identify all targets. Objective of the exercise: Camera handling with a 30 ° optic in a hysteroscopic environment to visualize the reach of all area’s of the uterine cavity
Ex 1: Camera Navigation SET UP The white uterus model with symbols is placed in the Neoderma vagina and placed in the EVE trainer Screen is equipped with a transparent target sheet which has a circle in the middle
Ex 1: Camera Navigation STARTING POSITION • Place the optic so that you have an overview of the entire cavity • Camera head with 30 ° optic in NON- DOMINANT hand • Rotate light cable with your DOMINANT hand for correct view Maximum time of the exercise is 180 sec
Ex 1: Camera Navigation
Ex 1: Camera Navigation PROCEDURE • Start your search by locating the first position 1A Zoom in to position the target circle on • the small character so that it is fully shown and readable. • Search and locate the corresponding CAPITAL character (A) • Continue this sequence until you reach the last position with small character ‘end’
Ex 1: Camera Navigation SCORING • If all 12 targets are identified within 180 sec Write down the time mm:ss:hh • If last position ‘end’ is not reached within 180 sec Write down the last identified small character (e.g. 8K, 48 ,…) Each station has 3 different uterine models. In order to eliminate the memory effect, the model is changed after EVERY run
Ex 2: Hand-eye coordination AIM To evaluate the skills of simultaneous camera handling and handling a hysteroscopic forceps,grasping an object and transporting it. SET-UP The white uterus model is placed ON TOP of the Neoderma vagina and placed in the EVE trainer
Ex 2: Hand-eye coordination STARTING POSITION • Place the optic so that you have an overview of the entire cavity • Camera head in NON-DOMNANT hand • Use your DOMINANT hand for grasper and rotation Maximum time of the exercise is 180 sec
Ex 2: Hand-eye coordination
Ex 2: Hand-eye coordination PROCEDURE • Identify and remove 14 black rods from the walls. • Leave the rods in the cavity • Make sure you count each rod, after the last rod is removed and placed, time is stopped. • Reset the clock to 00:00:00 and change participant. • Perform the exercise 3 times
Ex 2: Hand-eye coordination SCORING • All 14 pins removed within 180 sec Write down the time mm:ss:hh • Time limit of 180 sec elapsed Count the number of pins removed and write down the number If the participants damages the grasping forceps during the exercise this will result in a minimal score and the exercise is stopped.
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