Nested EPA: Mobilization of Left Colon

Nested EPA: Mobilization of Left Colon

Mobilization of left colon along the white line of Toldt off of the retroperitoneum. Identifies avascular plane and quickly makes corrections when deviating from plane. Does not include splenic flexure mobilization.

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Date of Assessment*

Rotation*

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Anatomy*

Names but requires prompting to identify anatomy including white line of Toldt, blood supply, and retroperitoneal structures (ex: left ureter, iliac vessels).

Demonstrates basic understanding of anatomy in straightforward cases

Demonstrates understanding of anatomy in straightforward cases. Identifies but cannot adapt to abnormal anatomy discovered intraoperatively including re-operative field, aberrant vascular anatomy, or advanced pathology.

Easily adapts to abnormal anatomy.

Surgical Technique*

Handles instruments safely but tentatively. Follows intraop directions. Displays coordinated hand movements for simple maneuvers under direct instruction but inefficient w/ basic skills.

Displays some coordination of instruments, but tissue handling is inconsistent w/ both hands. Requires some prompting to stay in correct dissection plane and avoid injury to nearby structures.

Consistently displays careful tissue handling. Creates tension and counter tension during dissection. Gets into and stays in correct dissection plane and avoids injury to nearby structures. May require assistance in complex cases or re-operative fields.

Careful tissue handling and avoids injury in straightforward and complex dissections

Steps of Procedure*

Needs prompting to articulate steps of mobilization

Articulates basic steps but needs direction to move case forward (follow along white line of Toldt, stay superficial to retroperitoneum, not injure spleen or enter Gerota's fascia). Distinguishes between medial to lateral vs lateral to medial dissection.

Mobilizes colon in straightforward case but needs guidance in complex case (re-operative, inflammation, scarring, large mass)

Mobilizes colon in complex case. Walks junior residents through straightforward case. Implements plan when deviation from initial plan is required.

Dealing with Potential Error / Complications*

Evaluates basic complications (oozing, deviation from plane). Does not articulate the techniques to minimize severe complications (injury to colonic mesentery, left ureter, spleen, pancreas).

Manages basic complications. Articulates techniques to minimizes severe complications.

Manages basic complications. Implements techniques to minimize severe complications.

Takes appropriate precautions to minimize common complications (ex: approaches mobilization at different angles). Implements early management plans for severe complications.

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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