Nested EPA: MIS Entry to Abdomen

Nested EPA: MIS Entry to Abdomen

Robotic and laparoscopic entry and subsequent port placement (ex: Hasson, Veress, OptiView)

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Date of Assessment*

Rotation*

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Anatomy*

Describes the layers of the abdominal wall

Describes safe points of entry (Palmer's point, periumbilical)

Interprets pre-op imaging to determine safe entry points. Recognizes scenarios that increase risk of MIS entry (ex: prior surgical hx/scars, likelihood of adhesions, pathology, pregnancy, prior mesh placement)

Independently develops plan for MIS entry in both straightforward and complex anatomy

Surgical Technique*

Handles instruments safely but tentatively. Displays inefficient and uncoordinated hand movements under direct instruction.

Performs direct visualization techniques (Hasson) with guidance. Displays some coordination of instruments, but tissue handling is inconsistent with both hands.

Performs direct visualization techniques (Hasson) independently and closed entry techniques with guidance. Consistently demonstrates careful tissue handling.

Performs both closed and open entry techniques independently in both straightforward and complex cases. Careful tissue handling and avoids injury.

Steps of Procedure*

Requires prompting to articulate steps of operation

Articulates basic steps and requires active direction to move case forward

Performs safe entry into the abdomen using the different entry techniques (Veress, OptiView, and/or Hasson) in straightforward case

Performs MIS entry into the abdomen in complex case (able to perform entry at Palmer's point). Walks junior residents through safe MIS entry into the abdomen in straightforward case

Dealing with Potential Error or Complications*

Unable to recognize when to deviate from initial entry plan

Recognizes when deviation from the initial entry plan is required (ex: unsuccessful first attempt, insufflation of subcutaneous space, or stuck omentum)

Devises and implements a plan when deviation from initial entry plan is required

Implements early management steps when an intraop complication (ex: hollow viscus or solid organ injury or vascular injury during entry) is identified

Overall Performance*

Limited Participation - Demonstrates understanding of information and has very basic skills

Direct Supervision - Demonstrates understanding of the steps of the operation but requires direction through principles and does not know the nuances of a basic case

Indirect Supervision - Can do a basic operation but will not recognize abnormalities and does not understand the nuances of an advanced case

Practice Ready - Can manage more complex patient presentations and operations and take care of most cases

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