SURGICAL LAPAROENDOSCOPIC FELLOWSHIP CURRICULUM OF STATEN ISLAND UNIVERSITY HOSPITAL

Edited by:

George S.Ferzli, FACS

Alphonse M. Pecoraro, Jr., MD

TABLE OF CONTENTS

Part One: Surgical Laparoendoscopic Fellowship Goals

Part Two: Program Organization/Requirements

Part Three: Clinical Objectives

Part Four: Lectures, Teaching, and Research Responsibilities

Part Five: Progress Assessment and Evaluation

PART ONE: SURGICAL LAPAROENDOSCOPIC FELLOWSHIP GOALS

Laparoendoscopic techniques to treat disease have become commonplace in the medical/surgical theater in the past decade, but few formal training programs exist to teach these skills to surgeons. The ability to teach such procedures during the five-year general surgical residency has significant limitations in that few surgeons are trained in advanced laparoscopic procedures and the referral base needed to establish a broad exposure to the implementations of these techniques exists in few centers.

Being at the forefront of the laparoscopic surgical revolution, Staten Island University Hospital, under the direction of our Laparoscopic Surgical Director, George S. Ferzli, NID, FACS, we are able to provide a Laparoendoscopic Fellowship position to train surgeons in this rapidly advancing field.

Our multidisciplinary program will expose the surgeon to all aspects of laparoscopic, thoracoscopic, and endoscopic procedures by those who routinely perform these procedures and in some cases, developed the procedure.

Our final goal is to develop a surgeon who will be able to perform complex laparoendoscopic procedures and be able to go into other communities/centers and disseminate these skills to other surgeons.

PART TWO: PROGRAM ORGANIZATION/REQUHMMENTS

Program length is one year.

Requirement for application is the completion of nationally or internationally recognized general surgical residency program and be either Board eligible or Board certified in General Surgery.

The Program Director, George S. Ferzli, NID, FACS, will be responsible for the overall organization of the program as well as being a source of much of the clinical instruction. Subspecialists in the areas of urology, gynecology, thoracic/cardiac surgery, gastroenterology, and pulmonary will also be assigned to guide/instruct the fellow in their areas of expertise.

Certificate of completion will be given at the successful completion of year-long fellowship outlining areas of special training

PART THREE: CLINICAL OBECTIVES

The following list of objectives include the problems and procedures that the fellow will be exposed to and trained to perform. He/she will also receive didactic instruction in each of the listed categories in order to develop a full understanding of the diagnosis, preoperative evaluation, procedure, and postoperative care and follow-up of patients treated with these modalities in therapy. By participating in such activities, the surgeon should become proficient in a wide range of complex and advanced laparoscopic/thoracoscopic procedures.

3.1 Laparoscopic Biliary Surgery/Pancreatic Surgery

  1. Cholecystectomy: Basic and Advanced
  2. Common Bile Duct Exploration
    • Transcystic
    • Choledochotomy
  3. Biliary Bypass
    • Cholecystojejunostomy
    • Choledochojejunostomy
  4. d. Laparoscopic Cholangiography
  5. e. Pancreatic Resection (Benign/Malignant/Whipple Procedure)
  6. f. Pancreaticojejunostomy 3.2 Laparoscopic Gastric Surgery
    1. a. Anti-Reflux Procedures
    2. b. Vagotomy (Truncal, Selective, Supraselective)
    3. c. Gastrostomy
    4. d. Gastrojejunostomy
    5. e. Gastric Bypass/Gastric BandingNertical Banded Gastroplasty
    6. f Gastric Resection
    7. g. Cystgastrostomy (Pseudocysts) 3.3 Laparoscopic Esophageal Surgery
      1. a. Esophageal Achalasia
        • Thoracic Approach
        • Abdominal Approach
      2. b. Surgical Treatment of Esophageal Spasm
      3. c. Paraesophageal Hiatal Hernia
      4. d. Esophageal Resection (Benign/Malignant) 3.4 Laparoscopic Solid Organ Surgery
        1. a. Liver Biopsy
        2. b. Splenectomy (Partial/Total)
        3. c. Adrenalectomy
        4. d. Partial Liver Resection (Hepatic Lobectomy)
        5. e. Resection of Splenic Cyst
        3.5 Laparoscopic Bowel Surgery
        1. Small Bowel Resection
        2. Mechel's Diverticulectomy
        3. Adhesiolysis
        4. Enteric Diversion
        5. Colectomy
        6. Assisted Abdominoperineal Resection
        7. Appendectomy
        8. Pyloroplasty
        9. Pyloromyotomy 3.6 Laparoscopic Hernia Surgery
          1. Inguinal Hernia
          2. Ventral Hernia
          3. Diaphragmatic Hernia (Congenital/Traumatic)
          4. Incisional Hernia
          5. Hiatal Hernia 3.7 Thoracoscopic Surgery
            1. Diagnostic/Biopsy
            2. b. Pericardiectomy
            3. c. Pulmonary Resection (Lobectomy/Pneumonectomy)
            4. d. Splanchnicectomy
            5. e. Minimally Invasive CABG
            6. f. Minimally Invasive Valvulo Surgery
            7. g. Minimally Invasive Congenital Defect Surgery
            8. h. Sclerotherapy (Pleurodesis)
            9. i. Decortication
            3.8 Laparoscopic Urologic Surgery
            1. Ureterolysis
            2. Partial Nephrectomy/Ureterectomy for Duplicate System
            3. Nephrectomy
            4. Staging Pelvic Lymphadenectomy for Prostate Cancer
            5. Radical Prostatectomy
            6. Varicocelectomy
            7. Cystectomy
            8. Undescended Testis
            9. Bladder Neck Suspension
            3.9 Laparoscopic Gynecologic Surgery
            1. Laparoscopic Assisted Vaginal Hysterectomy
            2. Ovarian Cystectomy
            3. Ectopic Pregnancy
            4. Diagnostic Laparoscopy - Staging
            5. Therapeutic Laparoscopy - Endometriosis
            6. laparoscopic Infertility Surgery
            3.10 Laparoscopy in Trauma
            1. Diagnosis in Penetrating Injury
            3.11 Laparoscopic Spine Surgery/Neurosurgery
            1. Exposure of Thoracic and Lumbar Spine
            2. Therapeutic Intervention
            3.12 Vascular Surgery
            1. Vein Ligation and Stripping
            2. Endoscopic Vein Harvesting
            3. Aortoiliac Bypass
            4. Aneurysm Resection
            5. Visceral Artery Aneurysm
            6. Endovascular Procedure
            3.13 Endoscopy
            1. Diagnostic (With Biopsy) -Esophagogastricduodenoscopy -Colonoscopy - Bronchoscopy
            2. Therapeutic - ERCP - PEG - Percutaneous Tracheostomy -Bronchoalveolar Lavage
            3.14 Miscellaneous Topics
            1. Laparoscopy in Pregnancy
            2. Laparoscopy in Pediatric Population
            3. Carpal Tunnel Release
            4. Face Lift

            PART FOUR: LECTURES, TEACHING, AND RESEARCH RESPONSEBILITY

            Lectures in all areas as outlined in Part Three will be given to the Fellow.

            The Fellow will also be responsible for developing lectures and teaching the surgical resident staff in the above subjects once he/she has become fluent in the topic. The major purpose of this is to develop the Fellow's teaching skills to further advance our stated goal to disseminate laparoendoscopic surgical knowledge.

            The Fellow is encouraged to participate in our active research activities and is expected to submit papers for publication and develop posters and presentations for laparoscopic meetings.

            The Fellow will be required to attend the national SAGES meeting and other national and international meetings to gain exposure to the laparoscopic community and become aware of the new developments in the field and hopefully actively participate in the proceedings.

            The Fellow will always be exposed to the newest technology and instruments (e.g. robotics) in order to stay on the cutting edge of the laparoscopic field and develop new procedures

            PART FIVE: PROGRESS ASSESSMENT AND EVALUATION

            Monthly, the Fellow will meet with the Director to assess his/her progress.

            Evaluation will be based on feedback of all involved in the Fellow's instruction and are to be submitted in written form.

            The Fellow will also keep account of all procedures in which they assisted or performed and this list will be evaluated quarterly to insure adequate exposure in all areas listed in Part Three. A final list will be submitted upon completion of the year-long program.

            A diploma signifying successful completion of the fellowship will be given to those fellows who successfully complete all the above listed objectives in this curriculum.

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