Guidelines for Training in Gynaecological Endoscopic Surgery Levels of Training in Laparoscopic Surgery Level I Basic Procedures The minimium requirement is the performance of 20 supervised diagnostic laparoscopies and/or tubal ligations under video-control before being allowed to operate unsupervised. This level of training is to establish techniques of laparoscopy with special emphasis on hand eye coordination using TV monitor. Level 2 Minor Procecdures The minimum requirement is the supervised performance of 20 of the following procedures before performing unsupervised surgery: 1. Salpingectomy for tubal pregnancy in the absence of haemodynamic instability 2. Simple adhesiolysis 3. Salpingectomy for hydrosalpinx with mild pelvic adhesions 4. Cautery of minor stage endometriosis (AFS Stage I-II disease) 5. Myolysis 6. Ovarian drilling 7. Aspiration / fenestration of cyst Level 3 Intermediate Procedures This level of procedures should be carried out with the assistance of an experienced laparoscopist until training is judged to be satisfactory. A minimum of 10 operative procedures should be performed before appropriate skills might be developed, although the exact number may vary between individuals. The following procedures are considered as appropriate for this level: 1. Oophorectomy or cystectomy for benign ovarian cysts of less than 8 cm 2. Laparoscopic management of moderate endometriosis (AFS Stage III disease) 3. Salpingostomy 4. Myomectomy for pedunculated fibroid Level 4 Mojor Procedures This level of laparoscopic surgery should be performed by surgeons who have achieved level 3 competence. At least 20 procedures should be performed under supervision before these surgeons are considered competent to operate unsupervised. The following procedures are considered as level 4: I. Hysterectomy 2. Myomcctomy for non-pedunculated fibroid greater than 3 cm. 3. Laparoscopic management of large benign ovarian tumours (>8cm.) 4. Laparoscopic management of severe endometriosis (AFS Stage IV disease) 5. Adhesiolysis for severe pelvic adhesions, enterolysis and ureteric dissection 6. Laparoscopic management of pelvic abscess 7. Retropubic bladder neck suspension 8. Uterosacral nerve ablation Level 5 Advanced Procedures This advanced level of laparoscopic surgery should only be performed by experienced laparoscopists who are well recognized for their expertise. The following procedures are considered as level 5: I. Lymphadenectomy 2. Radical hysterectomy for malignant conditions 3. Pelvic floor support other than colposuspension 4. Presacral neurectomy Levels of Training in Hysteroscopic Surgery Level 1 Basic Procedures The minimum requirement is supervised performance of 20 diagnostic hysteroscopies before being allowed to operate unsupervised. Level 2 Minor Procedures The minimum requirement is supervised performance of 10 minor operative procedures before operating unsupervised. The following procedures are considered as level 2: 1. Hysteroscopic polypectomy 2. Proximal fallopian tube cannulation 3. Division of mild synechiae Level 3 Major Procedures This level of surgery should be performed by surgeons experienced in hysteroscopic surgery. The following procedures are considered as level 3. 1. Endometrial ablation/resection 2. Division of uterine septum 3. Resection of submucosal fibroid 4. Division ofsignificant synechiae Revised 1998 Endoscopic Surgery Subcommittee