1. Centres must demonstrate a commitment to excellence in Minimally Invasive Gynecological Surgery (MIGS) by:
- Complying with regulatory requirements as stated below
- Putting into place an effective quality management system
- Continuously improving the training centre.
2. Centres must have performed a minimum of 100 qualifying gynecological laparoscopic procedures and 50 qualifying hysteroscopic procedures in the preceding 12 months. A minimum number of 20 vaginal procedures should be included if such services are available in the preceding 12 months (
qualifying procedures refer to Appendix A).
3. Centres must have a Physician Programme Director* for MIGS, who is a specialist in Obstetrics and Gynaecology. The Programme Director must be officially appointed through centre’s standard appointment process and he/she must participate in relevant decision-making administrative meetings of the centre. *Programme director must be appointed or in the process of being appointed as a APAGE Fellow in MIGS, providing leadership, best practices, research, support and training for the purpose of Minimally Invasive Surgery.
4. Centres must have the full range of consultative services required for effective care of MIGS patients and their potential complications. This includes a Post-Anesthesia Care Unit, High Dependency and/or a Critical Care Unit. There should be 24-hour ACLS Certified Physicians on-site. General Surgeons, Urologists, Radiologist, and Vascular Surgeons should be available. If there are none of these supportive specialties on-site, referral systems should be in place.
5. Centres must have qualified on-call coverage. Physician on-call should either be a gynaecologist or other qualified physicians who are able to identify and treat complications of MIGS when they occur. Centres must provide a list of qualified personnel (OR personnel and nursing staff).
Equipment and Instruments
A full line of surgical instruments and related equipment must be available to provide appropriae perioperative care for MIGS patients. Training for MIGS- related surgical equipment to allied healthcare professionals must be provided and documented by the centre.
Informed Consent
MIGS patients must be provided with comprehensive pre-operative patient education regarding MIGS procedure. Centres and surgeons must demonstrate a process for obtaining consent.
Clinical Pathways
Centres must adhere to clinical pathways that facilitate the standardization of peri-operative care for MIGS procedure. Procedures must be standardized for all MIGS Surgeons.
- Intraoperative anaesthesia, including monitoring and airway management
- Perioperative care, including monitoring, pain management and airway management
- DVT prevention and managementInstructions for the management of perioperative and postoperative complication warning signs such as tachycardia, fever or haemorrhage
- Evaluation and plan of action for patients at high risk for malignancy including when a malignancy is detected
- Fluid management in hysteroscopy
- Preoperative patient preparation checklist, including education, consent and instruction
Training
Centres must provide ongoing, regular scheduled in-service education programs in MIGS. The team should be trained to recognize postoperative complications and manage them appropriately, involving other interdisciplinary cross referrals when necessary. Training curriculum provided should include content that will enable staff to have a basic understanding of MIGS, appropriate management of MIGS patient including identifying early signs and symptoms of post-operative complications.
Centres must have a designated surgical team and support staff. The team should include nurse coordinators or advanced practice nurses trained in MIGS to care for MIGS patients. MIGS team must also provide education and care to MIGS patients.
Continuous Quality Assessment
Centres must provide prospective outcomes data on all patients who underwent MIGS procedures. Audits are encouraged to reflect an appropriate standard of care.