Caritas Institute of General, Minimal Access and Bariatric Surgery

 

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 certificate 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

This programme is to adequately prepare general surgeons in the art and science of Minimal Access Surgery which will benefit the patients.

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

• The candidate 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 candidate 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 candidate will be provided with the necessary stimuli to pursue a successful career in either private practice or academic surgery upon completion of the certificate programme.

Aims and Objectives

To train a specialist to be capable of

• Improving knowledge in MIS
• Aim to practice MIS as an armamentarium.
• Teaching, research and auditing
• Coordinating and promoting collaboration in organizing the services
• 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-a)Ensuring patient understanding and consent for MAS. b)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 candidate 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. Candidates 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

Assesment

• 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.

Postings 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.

Disclaimer : This programme is not recognised by NMC/State medical councils and intended only for skill upgradation.