Fellowship in Minimal Access Surgery / F-MAS

 

Program Overview

The course shall be of one-year duration from the date of commencement of academic session.

Eligibility For Admission :

• MS (General Surgery) /DNB(General Surgery)
• Other Eligibility Condition : The candidate should be registered with either the National Medical Commission (NMC) or Kerala Medical Council.

Criteria For Admission

Selection for Fellowship Programme shall be done by an Admission Board of the Institute strictly on merit. It will consist of two-step process –Written Entrance Examination followed by Counselling / Personal Interview (PI).

Goals

Due to lack of adequate educational programs in MIS and this programme is to adequately prepare general surgeons in the art of Minimal Access Surgery which will benefit the patients.

The goal of the MIS Fellowship is to provide the fellow with the necessary training and education to be comfortable in the performance of a wide variety of minimally invasive operations.

• The fellow is exposed to the broad applications of minimally invasive surgery, including all basic laparoscopic surgery and bariatric surgery, surgery for gastroesophageal reflux disease (GERD), and solid organ surgery.
• The Fellow will have ample opportunity to participate in both basic science and clinical research, and scholarly activity with presentations in national and international symposia is expected.
• The Fellow will be provided with the necessary stimuli to pursue a successful career in either private practice or academic surgery upon completion of the Fellowship.

Aims And Objectives

To train a specialist to be capable of

• Improving knowledge in MIS
• AimtopracticeMISasanarmamentarium.
• Teaching, research and auditing
• Coordinatingandpromotingcollaborationinorganizingtheservices
• Providing leadership in developing research within the specialty

Course of Study

Clinical Sciences

• Basic General and Laparoscopic surgery Sciences
• Anatomy of abdomen, and thorax
• Laparoscopic techniques -Principles of laparoscopic techniques,includingsuturing,knot tying and tissue handling.
• Pneumoperitoneum
• Ports positioning and methods and technologies
• Operating Room Setup and positioning of patient
• Recommended Instruments -Familiarization with surgical tools and equipments used in MAS
• Specimen Retrieval Techniques
• Control of bleeding
• Coagulation and dissection techniques ,management of intraoperative complications and troubleshooting.
• Role of the Team:Understanding the roles of Surgeons,Assistants,and other team members.
• Preoperative Assessment:Evaluating and preparing patients for MAS
• PatientSelection:Criteria for MAS suitability and contraindications.
• Postoperative Care:Post op care specific to MAS,including pain management and potential complications.
• Patient education:Educating patients on postoperative care and follow-up
• Ethics and Safety
  • Ensuring patient understanding and consent for MAS.
  • Adherence to safety standards and protocols in MAS.
• Laparoscpic procedures - cholecystecomy, Hernia (inguinal and incisional), Appendix, Rectal prolapse, Fundoplication, small bowel resection and anastomosis, spleen, VATS Esophagus, Lap nephrectomy, Hysterectomy, ovarian cyst, Gastrojejunostomy

Recent Advances

• Recent Advances in laparoscopic surgeries
• Lap cholangiogram
• Laparoscopic assessment of vascular structures, and control of bleeding major vessels
• Intraoperative sonography
• When to convert to open surgery
• Laparoscopic liver resection and donor surgery for kidney and liver, pancreatic surgeries, Eshophagectomy, Colon and rectal surgeries, gastrectomy, for malignancies, CBD exploration, reteroperitoneal surgery
• Hand sewen anastomosis of bowel, colon, CBD, pancreas, Esophagus
• Laparoscopic bariatric surgery

Components of the Program :

The activities of the fellow will be a blend of clinical experience, research, and teaching responsibilities for medical students and General Surgery residents. Clinical experience is to include both General and Laparoscopic cases consisting of documentation,Out Patient and ward works and operating room assisting. Fellows have performed both basic science research, as well as clinical research. Teaching responsibilities will range from formal Grand Rounds presentations for the Department of Surgery to informal clinical instruction in the operating room and surgical clinic.

The activities will be divided as follows:

• Clinical 60%
• Research 20%
• Teaching/Education 20%

Basic Module In MIS FOR GENERAL SURGEONS :

• Diagnostic Laparoscopy
• Laparoscopic Appendectomy
• Laparoscopic Cholecystectomy
• Laparoscopic Adhesiolysis

Advanced module in MIS For General Surgeons :

• Laparoscopic Herniaplasty Direct – TEP REPAIR and TAPP REPAIR and IPOM/IPOM Plus for Ventral Hernia
• Laparoscopic Perforation Closure
• Nissen Fundoplication for GERD and Hiatus Hernia
• CBD Exploration using C-Arm control
• Laparoscopic Splenectomy
• Assisted large and small bowel surgeries
• Liver resections
• Pancreatojejunostomy and Cystogastrostomy for Pseudocysts of pancreas.
• Laparoscopic Rectopexy for prolapsed rectum.
• Laparoscopic AR or APR/Right and left colectomy
• Trans – Hiatal Esophagectomy
• Gastrectomy for Ca. Stomach
• MeckelsDiverticulectomy
• Bariatric and Metabolic Surgery
  • Sleeve Gastrectomy
  • Gastric Bypass - MGB and RGB

Assessment

• Periodical internal assessment (2 per year), both in theory and clinical should be made for every candidate.
• Internal assessment will be made on day to day work of the trainee.

Posting in Various Units

• General Surgery - 10 months
• Surgical Gastroenetrology - 1 month
• Gyenecology - 15 Days
• Urology - 15 Days

Teaching and Training Method

The fundamental components of the teaching programme should include :

• Case presentations & discussion- once a week
• Seminar – Once a week
• Journal club- Once a week
• Grand round presentation (by rotation departments and subspecialties) - once a week
• Faculty lecture teaching- once a month
• Clinical Audit-Once a Month
• A poster and have one oral presentation at least once during their training period in a recognized conference.

The rounds should include bedside sessions, file rounds & documentation of case history and examination, progress notes, round discussions, investigations and management plan interesting and difficult case unit discussions.

The training program would focus on knowledge, skills and attitudes (behavior), all essential components of education. It is being divided into theoretical, clinical and practical in all aspects of the delivery of the rehabilitative care, including methodology of research and teaching.

Theoretical: The theoretical knowledge would be imparted to the candidate through discussions, journal clubs, symposia and seminars. The students are exposed to recent advances through discussions in journal clubs. These are considered necessary in view of an inadequate exposure to the subject in the undergraduate curriculum.

Symposia: Trainee would be required to present a minimum of 20 topics based on the curriculum in a period of one year to the combined class of teachers and students. A free discussion would be encouraged in these symposia. The topics of the symposia would be given to the trainees with the dates for presentation.

Clinical: The trainee would be attached to a faculty member to be able to pick up methods of history taking, examination, prescription writing and management in rehabilitation practice.

Bedside: The trainee would work up cases, learn management of cases by discussion with faculty of the department.

Journal Clubs: This would be a weekly academic exercise.. The candidate would summarize and discuss the scientific article critically. A faculty member will suggest the article and moderate the discussion, with participation by other faculty members and resident doctors. The contributions made by the article in furtherance of the scientific knowledge and limitations, if any, will be highlighted.

Research: The student would carry out the research project and write a thesis/dissertation in accordance with NBE guidelines. He/ she would also be given exposure to partake in the research projects going on in the departments to learn their planning, methodology and execution so as to learn various aspects of research.

The candidate before completing course shall —

• attend at least one State/National Conference
• present at least one paper and one poster in a conference.
• publish at least one article in a journal.

Log Book

A candidate shall maintain a log book of operations (assisted / performed) during the training period, certified by the concerned post graduate teacher / Head of the department / senior consultant. The log book should show evidence that the before mentioned subjects were covered (with dates and the name of teacher(s) The candidate will maintain the record of all academic activities undertaken by him/her in log book .

• Personal profile of the candidate
• Educational qualification/Professional data
• Record of case histories
• Procedures learnt
• Record of case

Demonstration / Presentations

Every candidate, at theend of the course, will be required to produce performance record (log book) containing details of the work done by him/her during the entire period of training as per requirements of the log book. It should be duly certified by the supervisor as work done by the candidate and countersigned by the administrative Head of the Institution.

In the absence of production of log book, the Certificate will not be issued.

Reference Book & Journals

Books

• Mastery of Endoscopic and Laparoscopic Surgery. Nathaniel Soper, Lee Swanstrom, Steve Eubanks.
• Laparoscopic Surgery of the Abdomen. Bruce MacFadyen, Maurice Arregui, Steve Eubanks, Doulgas Olsen.
• Laparoscopic Surgery: Principles and Procedures. Daniel B. Jones
• Laparoscopic Abdominal Surgery by John .N.Graber
• Complication of Laparoscopic surgery by Robert W.Bailey
• Atlas of surgical endoscopy by Jeffrey L.Ponsky.
• Laparoscopic Bilary Surgery second edition by ALFRED CUSCHIERYE GEORGE BERCI
• Tips & Techniques in Laparoscopic Surgery by Jean Louis Dulucq
• Laparoscopic Cholecystectomy difficult cases and creative solutions by AvranCoopaman
• Gastro International Endoscopy clinics of North America by Jacques Van Down MD
• Laparoscopic Urologic Surgery by Leonard G.Gomella
• Laparoscopic Surgery by Ballantyne
• Bileduct and Bile Duct Stones by George Berci
• Obesity Bariatric Surgery by Dulouq
• Surgical Laparoscopy by Karl A.Zucker
• Laparoscopic C Surgery Atlas for General Surgery by Garyc Vitale Josephs Sanfillo Jacques Pesissat
• Laparoscopic Surgery by Eddie Joe Reddict
• Operative Strategies in Laparoscopic Surgery by Edward .H.Phillips
• Laparoscopic Cholecystectomy problem & solution BY David C Dunn
• Current Techniques in Laparoscopy by David E Brooks
• Principles of Surgery by Shwartz'S
• Atlas of Laparoscopic Surgery by Theodoren.Pappas Edward .G.Chekan 30
• Mastery of Surgery by Robert J.Baker
• Bailey and Love's short practice of surgery 25TH edition by Norman S Williams
• Schiff's Diseases of the Liver 10TH Edition VOL1& by Eugene R.Schiff
• Text book of Surgery 18TH EDITION for modern surgical practice by Sabiston
• Atlas of General Surgery by Sir Devid Carter VOLUME 1&2
• SRB'S Manual of Surgery 3RD edition by Sriram Bhat M
• Atlas of Biliary tract surgery by John L. Cameron
• Mastery of surgery by Josef E Fischer Volume 1&2
• Maingot's Abdominal Operations 11TH edition by Michael J. Zinner
• Hamilton Bailey's emergency surgery 13TH edition by Brian W Ellis and Simon Paterson-Brown
• Text book of Operative general surgery ninth edition by Margaret Farquarson and Brenden Moran
• An Atlas of Gastroenterology by Cyrus R.Kapadia MD
• Atlas of Colonoscopy by Helmut Messmann
• Liver A Complete book on HepatoPancreato Biliary Diseases by StpehanosHadziannis
• Essential Surgical Practice by Butterworth Heinemann
• Operation surgery by Charcle Rob
• Pancreas Second edition by Hans Beger
• Surgery of Pancreatic Tumours by Shailesh V Shrikhande
• The Washington manual of surgery Fifth edition
• General and vascular surgery by Jamal J.Hoballah
• Pancreatitis: Advances in Pathobiology, Diagnosis and Treatment by R.W.Ammann
• The Ascrs manual of Colon and Rectal Surgery by Devid E. Beck
• Manual of Surgery by Schwartz's by Charles Brunicardi
• Manual on Clinical Surgery by S.Das 5TH Edition
• Netter's Gastroenterology 2ND edition by Martin H Floch
• French's Index of Surgical Differntial Diagnosis by Herold Ellis
• Diseases of the Pancreas current surgical Therapy by Hans G Beger

Journals

International Journals :

• The International College of Surgeons
• ELSA American Journal
• The Journal of the Royal College of Surgeons of Edinburgh
• The Surgeon : The Journal of the Royal College of Surgeons of Edinburgh and Ireland
• The Journal of Colon and Rectal Surgeons of India
• Sages Journal Grand Rounds
• British Journal of Surgery
• International Surgery Official Journal
• Surgical endoscopy
• Annals of laparoscopic and endoscopic surgery
• Journal of laparoendoscopic and advanced surgical techniques and videoscopy

National Journals :

• Indian Journal of Surgery
• Journal of IAGES
• Medical Journal Armed Forces India

Course Coordinators

• Dr. Jibu Eapen Mathew (Senior Consultant - General Surgery)
• Dr. Binto Mathew (Senior Consultant - General Surgery)

Intake : October

Number of Seats : 2