Three workshops were held for a total of 48 Australasian Urology trainees as part of the Annual Urology Training Week which was held in Perth, Western Australia in November, 2003. Facilitators were drawn from a faculty of local Urological Surgeons and local and interstate Gynaecological Oncologists. Members of the Board of Urology , RACS were invited to attend as Observers. The workshops were well received. The program was modified to embrace activities relevant to Urological Trainees. The objectives of the workshop and a sample program is attached.

The registration fee for all of the Urological Trainees was generously donated by Abbott Australia. Tyco Healthcare, Cook and MDA National also continued their support of this advanced workshop.

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 Urology workshop

Anatomy

To demonstrate and learn the surgical anatomy of the pelvis, kidney, ureter and posterior abdominal wall. The anatomical structures commonly involved in surgical injury will be reviewed, in particular bladder, bowel, ureter, autonomic nerves and blood vessels. Surgical anatomy relevant to bladder neck surgery, bladder and ureteric surgery, renal surgery, hysterectomy, removal of ovarian masses, retroperitoneal exploration of the pelvic side wall 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 the ureter from the pelvic brim to the bladder, noting the anatomical relations of the ureter.
• Dissect the vessels of the pelvic side wall.
• Identify and open the paravesical and pararectal spaces.
• Dissect the obturator fossa and contents, identifying the obturator internus muscle, obturator artery and vein, and obturator nerve.
• Dissect, identify and remove the major groups of pelvic lymph nodes.
• Identify levator ani and origin from tendinous arch.
• Identify ischial spine, inferior gluteal and int. pudendal arteries
• Trace the following: posterior division of internal iliac artery.
• Lumbosacral plexus, superior hypogastric plexus and hypogastric nerves.

Examination of prosected specimens:

• The Bony Pelvis
• Muscles and Nerves of the pelvis
• Arteries and veins of the Pelvis
• Ischiorectal fossa
• TVT and SPARC urinary incontinence procedure specimen
• Posterior abdominal wall

Surgical skills

Objectives:

• To demonstrate, practice and learn the following procedures: Repair of a transected ureter over a JJ stent, ureteric reimplantation into bladder, Boari flap, small bowel resection and anastomosis, formation of an ileal urinary conduit, Andersen-Hynes Pyeloplasty. 

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:

1. Perform a ureteric re-anastomosis over a JJ stent.
2. Perform a re-implantation of ureter on one side and creation of a Boari flap on the other. Psoas hitch.
3. 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.
4. Perform a pyeloplasty 
   

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 dissect the ureter and pelvic vessels.
• To perform a pelvic lymphadenectomy
• To perform a 'safe' hysterectomy.
• To perform hand-sewn bowel anastomosis.
• To perform an augmentation cystoplasty.
• To raise a colostomy or ileostomy
• To repair vascular injury.
• To demonstrate and practise the use of the 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)
• Skeletonize vessels of pelvic side wall and remove pelvic nodes
• Hand-sewn side to side small bowel anastomosis.
• Perform an augmentation cystoplasty
• Raise and fashion an ‘ileostomy’
• Arteriotomy and Venotomy & repair
• Use of overlay autogenous tissue (OAT) patch 
  

Case Presentations: Prevention & Management of Complications

• To present and discuss common clinical situations occurring during and after urological, gynaecological and pelvic surgery.
• To understand and learn approaches which lead to a reduction in surgical injury.

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 (urology trainees) 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.

Copyright © 2003, Anatomy of Complications. All Rights Reserved.