The 12th Anatomy of Complications Workshop was modified specially for Gynaecologic Oncology subspecialty trainees, and held in Perth on September 6 –7th, 2002. It was very successful and held in conjunction with a CGO subspecialty examination workshop on the preceding day.

By request, these workshops will be held again in 2004. The 27th Anatomy of Complications Workshop in Gynaecologic Oncology will be held in Perth on Friday 3rd and Saturday 4th September 2004.
A CGO subspecialty examination workshop will be held on Thursday 2nd September in Perth and details of this will be available from Ian Hammond & Gerry Wain in May 2004..

All anatomy of complications workshop programmes are 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:

1. Anatomy
2. Surgical Skills
3. Live Animal surgery
4. 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.

View programme for Gynaecologic Oncology workshop

Anatomy

To demonstrate and learn the surgical anatomy of the pelvis and posterior abdominal wall and it’s relevance to Gynaecologists and Gynaecologic Oncologists. The anatomical structures commonly involved in surgical injury and radical gynaecological cancer surgery will be reviewed including bladder, bowel, ureter, autonomic nerves and major blood vessels. Surgical anatomy relevant to radical gynaecological cancer surgery, bladder neck surgery, hysterectomy, ovarian masses, retroperitoneal exploration of the pelvic side wall, aortic and pelvic lymphadenectomy and prevention of damage to the autonomic nervous system will be covered. 

Anatomy review in the St John of God Interactive Seminar Room - Learners are seated in the front row! Cadaver dissection in progress with facilitator Examination of prosected specimens

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 Ian Hammond and John Taylor. Active participation by the learners and all facilitators is encouraged during this review process.

Following the anatomy review, Paul McMenamin introduces and supervises the practical anatomy session including cadaver dissection and examination of prosected specimens that 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:

• Dissect ureter from pelvic brim to the bladder.
  Note anatomical relationships to vessels, muscles, nerves and viscera.
• Dissect the vessels of the pelvic side wall.
  • Common iliac.
  • External iliac.
  • Internal iliac.
  • Branches of anterior division of internal iliac.
  • Uterine artery.
• Open paravesical and pararectal space.
• Dissect the obturator fossa and contents.
• Identify obturator internus muscle.
• Identify the obturator artery, vein & nerve.
• Identify levator ani and origin from tendinous arch.
• Identify ischial spine and trace inferior gluteal and internal pudendal arteries
• Dissect the aorta and vena cava from pelvic brim to the level of the renal vessels. 
  Note the origin of inferior and superior mesenteric vessels.
• Identify (and dissect if time permits):
  • Posterior division of the internal iliac artery.
  • Lumbosacral plexus.
  • Superior hypogastric plexus and hypogastric nerves.

Surgical skills

Objectives:

• To demonstrate, practice and learn the various surgical skills which may be needed to deal with unexpected and deliberate operative injury to bowel, bladder or ureter. To practice procedures less commonly performed but essential to the practice of gynaecologic oncology including repair of transected ureter, reimplantation of a ureter, psoas hitch, bowel resection and formation of a urinary conduit. 

John Taylor demonstrating ureteric repair Session in progress: Hill Int'l Surgical Workshop: Surgical session with freshly killed pig

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 a freshly killed pig for this practical session.

Polysorb, Caprosyn, Biosyn, and Surgipro sutures are donated to the workshop by Tyco 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:

• Perform a ureteric reanastomosis over a JJ stent.
• Perform a reimplantion of ureter on one side and creation of a Boari flap on the other.
• Prepare a segment of ileum for a conduit and perform a functional end to end small bowel anastomosis using a stapling device.
• Now fashion a urinary conduit using the Wallace technique as described.
• Perform a side to side hand sewn bowel anastomosis
• A demonstration of a colorectal stapled anastomosis will be performed using an AutoSuture EEA stapling device.

Live Animal Surgery

Live animal surgery at CAST Two operating tables in ‘sterile’ surgical theatre at CAST John Newnham welcoming gynaecologic oncology trainees to the September 2002 workshop

• To demonstrate the pelvic anatomy in the ewe.
• To confidently dissect the ureter and pelvic vessels.
• To perform a hysterectomy.
• To repair injury to bowel, bladder and ureter.
• To practice the technique of internal iliac artery ligation.
• To perform ureteric reimplantation, Boari flap and Psoas hitch.
• To perform a side to side bowel anastomosis.
• To raise a colostomy or ileostomy.
• To perform a stapled EEA colorectal anastomosis.
• To repair vascular injury: arteriotomy and venotomy.
• The use of the Overlay Autogenous Tissue (OAT) Patch.

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

These procedures are listed below:

• Open abdomen via midline incision
• Identify pelvic organs
• Dissect ureter 
• Perform hysterectomy (long cervix)
• Dissect vessels of pelvic side wall 
• Ureteric reimplantation into bladder
  Boari flap, Psoas hitch (Principles)
• Hand-sewn side to side small bowel anastomosis.
• Anterior resection using EEA stapling device (colo-colostomy)
• Raise ‘colostomy’ or ‘ileostomy’
• Vascular damage and repair:
  • Arteriotomy and Venotomy & repair
  • Use of OAT Patch in vascular repair
    

Case Presentations: Prevention & Management of Complications

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

Case presentation by participant in the Geoff Bird Clinical Staff Lounge

This is the final session and is held at King Edward Memorial Hospital for Women in the Geoff Bird Clinical Staff Lounge.

Prior to attendance, all participants are required to submit one case for presentation. This case would usually describe a surgical complication, or a difficult management decision. The presentation is given using Microsoft Power Point  with a maximum of four slides. Each case is allocated 15 minutes to include presentation and discussion.

This session is facilitated by Ian Hammond and John Taylor, 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.

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