Nested EPA: Entry of Lesser Sac

Nested EPA: Entry of Lesser Sac

Entry into the lesser sac through gastrocolic ligament, hepatogastric ligament, splenocolic ligament, splenogastric, or base of mesentery, while preserving colonic mesentery

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Date of Assessment*

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Anatomy*

Demonstrates basic understanding of stomach and foregut anatomy

Identifies some structures associated with stomach and foregut (ex: gastroepiploic vessels, gastrocolic ligament, pancreas)

Identifies all structures associated with stomach and lesser sac, but needs help identifying and managing abnormal anatomy identified intraop

Identifies all structures associated with stomach and lesser sac. Independently identifies abnormal anatomy and is able to adapt operative plan as needed.

Surgical Technique*

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

Performs basic dissection skills w/o oversight. Actively retracts and assists with basic portions of the operation. Maintains dissection plane but frequently deviates from correct plane. Requires guidance to return to correct plane.

Performs more advanced dissection skills, including providing appropriate tension and counter-tension. Identifies tissue planes and adapts tissue handling based on tissue quality.

Identifies intraop challenges (increased visceral fat, dense adhesions) that require careful technique. Adapts tissue handling to avoid tissue damage.

Steps of Procedure*

Requires prompting to articulate steps of entry into lesser sac

Articulates basic steps and requires active direction to move case forward (ex: needs prompting to ask for specific instruments/sutures)

Accesses lesser sac with occasional guidance, but would require guidance in complex cases (increased visceral fat, dense adhesions)

Performs lesser sac entry in complex cases. Walks junior residents through straightforward cases. Independently devises and implements plan when deviation from the initial operative plan is required.

Dealing with Potential Error / Complications*

Recognizes basic complications (ex: oozing or deviation from plane), but requires assistance to manage

Recognizes and manages basic complications with some guidance

Manages basic complications. Recognizes complex complications (ex: hollow viscus injury, active omental bleeding, injury to colonic mesentery), but requires assistance to manage.

Independently manages both straightforward and complex surgical 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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