SURGERY 7009OL - Minimally Invasive Surgery Theory II
Online - Quadmester 2 - 2014
General Course Information
Course Code SURGERY 7009OL Course Minimally Invasive Surgery Theory II Coordinating Unit Surgery Term Quadmester 2 Level Postgraduate Coursework Location/s Online Units 3 Contact Online Prerequisites SURGERY 7007OL Restrictions Available to MMIS students only Course Description The course will build on what was taught in Minimally Invasive Surgery Theory I. It will focus on methods of access to working spaces. Topics will include ports and instruments required for entry to working spaces and the effect that this has on the physiology and immunology of the human body. For example, students will learn about the physiology of the peritoneum during insufflations. The effects of different insufflations gasses will be considered. A variety of access techniques such as HALS, SILS, NOTES and robotics will be discussed. In addition, a leading expert will teach about how anaesthesia interacts with the various topics covered in the term.
Course Coordinator: Peter HewettAdditional Academic Staff
Name Phone Location Mr (Chrys) Indran Chrysantha Sri Lal Hensman MBBS (Hons) FRACS 03 9760 2777 firstname.lastname@example.org Melbourne Mr Alex Karatassas MBBS, FRACS 08 8222 6750 email@example.com The Queen Elizabeth Hospital Dr Dinesh TrehanMBBS, MS (Gen.Surg), DNB (Gen.Surg)FRACGP, FRACS 08 8182 9000 firstname.lastname@example.org Royal Adelaide Hospital Dr. Santosh Antony 0lakkengil, MBBS, DNB (Gen.Surg.), M.MinInvSu.(Aus), FIAGES 08 8123 6826 email@example.com Royal Adelaide Hospital
Name Phone Location Ms Sally Lauder 08 8222 7024 firstname.lastname@example.org The Queen Elizabeth Hospital
The full timetable of all activities for this course can be accessed from Course Planner.
Course Learning Outcomes
1 Describe the anatomy of the abdominal wall, muscles, blood vessels and nerves. 2 Describe the retroperitoneum and relevant anatomy to laparoscopic trocar entry including the anatomical basis of complications. 3 Describe the anatomical basis of preperitoneal and retroperitoneal working space creation. 4 Demonstrate a clear understanding of laparoscopic ports. 5 Explain and demonstrate how to set up for optimal ergonomic benefits in MIS. 6 Describe the oncological considerations in MIS. 7 Be able to communicate how robotics may improve the ability to operate in areas with limited access. 8 Describe the anaesthetic implications in relation to MIS. 9 Describe the issues with pain and measures to reduce the downsides and improve pain management in MIS procedures. 10 Be familiar with and understand the drivers of innovation and impediments.
University Graduate Attributes
This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:
University Graduate Attribute Course Learning Outcome(s) Knowledge and understanding of the content and techniques of a chosen discipline at advanced levels that are internationally recognised. 1-10 The ability to locate, analyse, evaluate and synthesise information from a wide variety of sources in a planned and timely manner. 1-10 An ability to apply effective, creative and innovative solutions, both independently and cooperatively, to current and future problems. 1-10 Skills of a high order in interpersonal understanding, teamwork and communication. 1-10 A proficiency in the appropriate use of contemporary technologies. 1-10 A commitment to continuous learning and the capacity to maintain intellectual curiosity throughout life. 1-10 A commitment to the highest standards of professional endeavour and the ability to take a leadership role in the community. 1-10 An awareness of ethical, social and cultural issues within a global context and their importance in the exercise of professional skills and responsibilities. 1-10
Students will require access to a computer and the internet.
All learning resources will be delivered online with online tutorials consisting of links to text, video and websites delivering relevant content.
Recommended ResourcesAll learning resources will be delivered online with online tutorials consisting of links to text, video and websites delivering relevant content.
Online LearningColloquy will provide the online learning system for students (no link available at time of writing)
Learning & Teaching Activities
Learning & Teaching ModesTheory II will be taught via online tutorials with directed learning to text, videos and websites.
The information below is provided as a guide to assist students in engaging appropriately with the course requirements.
Type No of Sessions Duration of Sessions (hrs) Total Hours Online tutorials 10 3 30 Exam 1 1 1 Reading/study time 10 6 60 Tutorial preparation 10 5 50 Exam preparation 15 10 Written Assignments 7 3 21 TOTAL workload per term 172
Learning Activities SummaryTerm 2
Week Topic Lecture 1 Abdominal Wall and Retroperitoneal anatomy This topic will provide an overview of abdominal wall anatomy and retroperitoneum implications of access. 2 Ergonomics This topic will explore the concept of ergonomics and how it applies to the field of minimally invasive surgery. 3 Ports and Abdominal Access Technology This topic will cover ports and current access technology. It will also address creating and maintaining working spaces, port closure and wound protection techniques. New innovations in body cavity entry such as HALS and SILS will be explored and discussed.
This topic also explores how surgery within the MIS environment is unique and distinct from the traditional open experience. The limitations of two dimensional visual display systems, ports with fixed fulcrums and the constraints and limitations in degrees of movement complicate and add to the level of technical difficulty in MIS. Efficient and safe MIS performance requires a superior knowledge of ergonomics.
4 Robotics This topic will introduce students to robotics and how they are used in spaces in MIS. Two obvious spaces are the peritoneum and thoracic cavity but working spaces can be formed in the retroperitoneum and pre-peritoneal planes. The advantages of this approach include reduced pain, avoiding intraperitoneal adhesions and closer proximity to relevant anatomy. 5 Physiological Effects of Pneumoperitoneumry This topic covers the fundamental aspects of the physiological effects to the pneumoperitoneum, including cardiovascular and pulmonary systems. It will also touch on insufflation gases including chemistry, absorption characteristics and physiological effects of different gases including methods and technology to warm and humidify gases. 6 Oncological Controversies This topic will address oncological issues and controversies in MIS such the possible risks in treating malignancy with MIS techniques? The topic will also cover what port site recurrence and whether this is a real problem. Whether MIS causes less immune suppression than open surgery and whether MIS has an overall advantage in regards to the human immune state. 7 Anaesthesia and Analgesia In this topic specific issues in anaesthesia and pain in MIS will be discussed. It will emphasise the importance of having a thorough understanding of the changes in physiology that the anaesthetist is faced with during MIS. 8 Surgical Innovation – Part 1 This topic will provide an overview of innovation in surgery. Over two weeks this topic will highlight modern concepts around innovation. The aim of this module is to highlight the pathway to innovation from concept to reality. The concept of innovation is not limited to specific individuals but an ability that is inherent to all. The module aims to give keys to the concepts around innovation and an understanding of the inherent road blocks to innovation.Column cell 9 Surgical Innovation – Part 2 10 Revision • Surgical Skills Workshop weekend
• Reading week
Specific Course RequirementsIn order to be eligible for this program, applicants must meet the following requirements:
• Students must be an experienced surgeon who has completed, or be within 1 year of completing, the FRACS, FRACOG (or equivalent).
• Students should have a surgical fellowship or consultant position with a major interest in minimally invasive surgery.
• Permanent residency or citizenship - to be a domestic applicant
• or hold a Temporary Business (Long Stay) Visa (Subclass 457) – to be an International applicant.
• Students must be resident in Australia.
Students should have a surgical fellowship or consultant position with a major interest in minimally invasive surgery. This surgical position is not automatically offered with the Master of Minimally Invasive Surgery and students are personally responsible for obtaining a suitable position. Job dates should coincide with the University of Adelaide quadmester dates.
Small Group Discovery ExperienceAll students will attend a Surgical Skills Workshop weekend
The University's policy on Assessment for Coursework Programs is based on the following four principles:
- Assessment must encourage and reinforce learning.
- Assessment must enable robust and fair judgements about student performance.
- Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
- Assessment must maintain academic standards.
Assessment Task Assessment Type Weighting Learning outcome(s) being addressed Written assignments Summative 40% 1-10 Discussion/group contribution and participation Participation 25% 1-10 Surgical skills workshop Summative 35% 1-10
Assessment Related RequirementsAll tutorials and workshops are compulsory.
Assessment DetailOverall assessment details:
• The surgical skills workshop will account for 35% of the overall assessment. It will include practical assessment and an open book exam.
• Written assignments will consist of four online written assignments. The assignments are either 1,000 or 2,000 words. All marks will go towards a total of 40% of the overall assessment.
• Discussion /group contribution and participation. Contribution to discussion groups and boards and contribution performance metrics will also be taken into account accounting for 25% of the overall assessment.
Individual assessment tasks:
Students are required to submit a 1,000 word (unless otherwise stated) assignment on the tutorial topic or contribute to discussion topics. Where it is an assigned discussion, students will be graded on the quality of their posts, not necessarily on the quantity—what is expected is substantive participation in all assigned discussions.
1. What are the key differences in the abdominal wall and peritoneal cavity between the neonate, child, and adult? Explain how these differences impact safety in MIS. Please give examples in your answer. (worth 10% of overall course grade)
2. Describe in detail the ergonomic factors that you must consider when performing a laparoscopic procedure. Include patient position, operative personnel, devices, instruments and give examples of ergonomic problems that you personally encounter. (worth 10% of overall course grade)
3. a) Compare the various surgical methods covered in this topic (HALS and SILS).
b) Which of these methods do you believe is most viable? Explain what leads you to this conclusion. How would you use these techniques in your practice? (Discussion)
4. a) In your opinion is robotics the future of MIS or just a fad? Explain your position providing examples and data that makes your case. (Discussion)
b) Research the latest developments in minisurgical robots. Based on your research, in your opinion what are the reasons for the market superiority of the Da Vinci robot? Explain your position and provide examples and data to support your statements. (Discussion)
5. What do you think of the mechanism that the Surgiseal Air Seal system uses? What are the potential advantages and disadvantages of using it? How might you use it in your own practice? (Discussion)
6. Identify the various functions and uses of the Alexis Wound Protector. What are the devices advantages and disadvantages? How many uses are there outside of wound retraction? (worth 10% of overall course grade)
7. Discuss the latest advances in postoperative analgesia. Identify those that you use in your practice, and describe their advantages and disadvantages and in what situations they are most appropriate. (Discussion)
8. In a 2,000 word essay: (worth 10% of overall course grade)
a) Describe the process of innovation and the barriers to innovation. Give examples from your own work.
b) List the five key steps in innovation.
c) List the common blocks to innovation.
Submission• All submissions relating to tutorials will be delivered online via Colloquy’s online system.
• Examination location and date will be communicated by Program Coordinator and/or Program Administrator.
• Exam result turnaround time will be a maximum of 14 days.
• Any queries relating to classroom contribution can be discussed directly with ProgramCoordinator.
• Students should refer to the University’s Academic Honesty and Assessment Obligations for Coursework Students Policy & Coursework Students: Academic Dishonesty Procedures for information regarding written submissions: http://www.adelaide.edu.au/policies/230/?dsn=policy.document;field=data;id=239;m=view
• Students should contact the Program Coordinator if;o They are unable to complete their tutorial obligations;o They are unable to attend an examination;o They are unable to attend the clinical immersion workshop;o They are unable to meet any deadlines that are set during the course.
Grades for your performance in this course will be awarded in accordance with the following scheme:
M10 (Coursework Mark Scheme) Grade Mark Description FNS Fail No Submission F 1-49 Fail P 50-64 Pass C 65-74 Credit D 75-84 Distinction HD 85-100 High Distinction CN Continuing NFE No Formal Examination RP Result Pending
Further details of the grades/results can be obtained from Examinations.
Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.
Final results for this course will be made available through Access Adelaide.
The University places a high priority on approaches to learning and teaching that enhance the student experience. Feedback is sought from students in a variety of ways including on-going engagement with staff, the use of online discussion boards and the use of Student Experience of Learning and Teaching (SELT) surveys as well as GOS surveys and Program reviews.
SELTs are an important source of information to inform individual teaching practice, decisions about teaching duties, and course and program curriculum design. They enable the University to assess how effectively its learning environments and teaching practices facilitate student engagement and learning outcomes. Under the current SELT Policy (http://www.adelaide.edu.au/policies/101/) course SELTs are mandated and must be conducted at the conclusion of each term/semester/trimester for every course offering. Feedback on issues raised through course SELT surveys is made available to enrolled students through various resources (e.g. MyUni). In addition aggregated course SELT data is available.
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Professor Peter Hewett
The Queen Elizabeth Hospital
Phone: 08 8222 6248
Professor Guy Maddern
Head of Discipline, Surgery
The Queen Elizabeth Hospital
Phone: 08 8222 8492 (Departmental Secretary)
MS Sally Lauder
The Queen Elizabeth Hospital
Phone: 08 8222 7024
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