The expertise of the teaching faculty at the Columbia University Medical Center’s MIGS Fellowship Program includes treatment of fibroids and abnormal bleeding, endometriosis and infertility, pediatric and adolescent gynecology, and urogynecology. With these areas in mind, the fellowship program will provide rotations in four main surgical approaches: laparoscopy, hysteroscopy, vaginal, and robotic surgery. In all four areas, there will be an emphasis on the mastery of the pelvic anatomy so that the fellow should be confident in navigating all spaces encountered in simple and complex pathology. A hands-on laparoscopic workshop using the cadaveric model will be held annually to gain skills in opening the retroperitoneal lateral and presacral spaces, ureterolysis, and isolation of the uterine arteries. An established dry-lab curriculum using laparoscopic pelvic trainers and robotic simulation will also ensure competency in laparoscopic suturing and mastery of the robotic system.
During rotations in laparoscopy and robotics, the trainee will demonstrate understanding of the principles of different energy modalities, show familiarity with safe techniques for peritoneal access and specimen removal, demonstrate competency in handling of tissue and use of available instrumentation, and show knowledge and skills for prevention and management of complications. Similarly, surgical principles, mastery of skills, and handling of equipment during the hysteroscopy rotation will be emphasized. In addition, the fellow will provide knowledge of the indications, options, and considerations necessary in the treatment of patients with infertility and adolescents with mullerian abnormalities.
During the vaginal surgery rotation, the trainee will be equipped with skills to become proficient in vaginal hysterectomy. The fellow will be able to articulate the specific challenges encountered during the vaginal approach and know the different techniques and devices available to overcome these challenges. At the end of the fellowship program, the fellow will be comfortable with the vaginal approach for large uteri and non-prolapsed conditions. The fellow will also rotate through the Pelvic Floor Clinic and will become familiar with diagnosis and treatment options for pelvic organ prolapse and incontinence. The use of cystoscopy for identification of ureteral and bladder injuries during surgery will also be emphasized.
The fellowship program includes a one-year rotation in research with an established expert in robotics and surgical innovation. At the end of the year, the fellow will be guided through the scholarly rigors of design and implementation of scientific experiments, interpretation of data, and manuscript writing. Research activities will also be available during clinical rotations. The fellow will be required to present a major thesis subject to jury defense at the end of the three-year program for graduation.
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