Minimally Invasive Gynecologic Surgery

Overview

The fellowship in Minimally Invasive Gynecologic Surgery (MIGS) at the Univeristy of Louisville was first established in 2001 under the direction of Drs. Ronald Levine and Resad Pasic. The Division of MIGS has a rich history of pioneering gynecologic laparoscopy: The first laparoscopic bilateral oophorectomy in the U.S. was performed at the University of Louisville by Dr. Ronald Levine in 1984. The first endoscopic course in the U.S. was conducted by Drs. Levine and Pasic in 2001. The division later partnered with AAGL in 2001 to establish the first endoscopic cadaver course in the U.S. This cadaver course has served many physicians both nationally and internationally in honing their knowledge and skills in gynecologic anatomy and laparoscopic techniques. 

In 2021, Dr. Pasic and the MIGS Fellow Dr. Megan Cesta performed the total laparoscopic hysterectomy on a 7.4 Kg uterus that turned out to be world's largest uterus taken out laparoscopically.

The MIGS program is a two year program which utilizes academic and private clinical settings to train fellows in gynecologic operative laparoscopy, hysteroscopy, endoscopy, and robotics. Since its inception, the program has graduated 20 fellows who now hold positions in both academic and private practice settings. Past graduates have won prestigious awards such as the AAGL 2008 and 2010 Jay M. Cooper Endowed Award; the 2010, 2011 and 2012 IRCAD, and AAGL Excellence in Suturing awards. Our faculty and fellows have also authored or coauthored 75 peer-reviewed publications in major journals and books.

Fellows are designated departmental “instructors” who serve as attendings with periodic service and call responsibilities. Fellows have unrestricted access to the fresh tissue human cadaver laboratory, learning and teaching pelvic anatomy and various surgical techniques to residents and medical students. In addition, each fellow participates in post-graduate courses in anatomy and advanced endoscopy held at the University of Louisville.

The fellows have the opportunity to learn robotic surgery on a dual console Intuitive daVinci Si unit that offers practice in refining clinical robotic endoscopic procedures. Upon completion of the program, the fellow will be able to confidently perform most advanced laparoscopic and hysteroscopic procedures and be eminently qualified to continue as an academic clinician in a supervisory position.

Facilities

The division maintains its major outpatient care facility at the University of Louisville HealthCare Outpatient Center (HCOC) where the MIGS attending and fellows see their private patients as part of the University of Louisville Physicians (ULP) group. This facility also provides access to a self-contained outpatient operating room.

A resident and faculty clinic is also housed within the Department of Ob-Gyn-Women’s Health office suite in the UofL Ambulatory Care Building (ACB).

Patients

The practice has a wide referral base, accepting patients from Kentucky, Indiana, Ohio, and West Virginia. In the immediate Louisville metropolitan area, the division draws from a geographical area of 1.3 million people within a 50-mile radius.

The division has clinical patient care hour’s five days per week with laboratory and ultrasound services on site.

Consults

The division receives consults from members of the gynecology generalist division within the department and from physicians throughout the region.

Research

Basic science research is conducted with departmental faculty members and Zhenmin Lei, MD, PhD. The following techniques are available in these investigator’s laboratories: Northern, Southern, Western and ligand blotting, covalent receptor cross linking, nested RT-PCR, cell transfections, antisense gene expression, gel mobility shift, cloning cDNAs, light and transmission electron microscopy, immunocytochemistry, immunoassays, cell and tissue culture, and in situ hybridization.

Curriculum

PGY5
The fellow’s time during the first year is spent with the division’s faculty attendings in direct preceptorship with an emphasis on learning anatomy, surgical instruments, preoperative preparation and postoperative management for outpatient surgery, diagnostic and operative hysteroscopy and laparoscopy, allowing for increased responsibility as the fellow’s skill level increases. Fellows also participate in a bi monthly cadaveric dissection in the laboratory.

Through guided experience by attendings, fellows learn diagnoses and treatments for patients with conditions that can be successfully managed with minimally invasive surgical techniques.

A portion of time is devoted to the development of a clinical, basic science, or video research project.

PGY6
Time is devoted to mastering the skills of myomectomy, hysterectomy, appendectomy, endometriosis, pelvic sidewall dissection, enterolysis, bowel repair, herniorrhaphy.

Fellows learn gynecologic urinary tract procedures and tubal reconstructive surgery. Procedural skills learned during the first year are honed during the second year, when the fellow assumes increased responsibility for the patient’s management care plan.

Each fellow is expected to have completed a research or video project by the end of the second year, which culminates in the annual research day presentation.

Didactics

The fellowship is a cornerstone of the gynecology division, which is committed to a strong teaching curriculum for members of the department and school of medicine, including faculty, residents, and medical students. As part of our educational mission, the division conducts:

  • weekly patient care conference to review previous / upcoming surgeries, including video review of previous surgeries
  • weekly seminar/didactic courses where fellows present assigned textbook chapters and preselected articles under the direction of a faculty mentor, as per the core reading assignments set forth by the AAGL
  • weekly pre-operative conference regarding all upcoming resident surgeries
  • laparoscopic surgery and dissection on minimally embalmed cadavers performed every other month with a second and third year resident

Fellows attend the department’s weekly Grand Rounds presentations, pertinent weekly Continuous Quality Improvement, preoperative gynecology conferences, morbidity and mortality conference, and Journal Club, all held within protected educational time.

Fellows present a Grand Rounds topic during the final year and conduct several resident didactics during each year of training.

Faculty

Link to Minimally Invasive Gynecologic Surgery Faculty

Fellows

Petra Chamseddine, MD, PGY 6

Amira Quevedo, MD, PGY 5

Suporting Faculty

Jonathan Reinstine, MD, Fellowship Co-Director, private practitioner, Associates in OB/GYN

Lori Warren, MD, Fellowship Co-Director, private practitioner, Women First of Louisville.

Research

Zhenmin Lei, MD, PhD, Professor and Interim Director of Research

Jeremy Gaskins, PhD, Biostatistician

Female Pelvic Medicine

Sean Francis, MD

Stacy Lenger, MD

 

How to Apply

The Fellow Candidate Application for the 2021-2023 Fellowship cycle is now available. The application will be available on the AAGL website at the following link:  AAGL Fellowship Application Page.

Important Dates

Fellow Candidate Application/Interview Schedule

  • May 3, 2021: Deadline to Submit Applications
  • May 25, 2021: First Wave of Interview Notifications
  • June 1, 2021: Deadline for Candidates to Accept/Decline Interview Invitation
  • June 2, 2020: Second Wave of Interview Notifications

NRMP Schedule

  • June 23, 2021: Match Opens
  • August 4, 2021: Ranking Opens
  • September 8, 2021: Quota Deadline
  • September 22, 2021: Ranking Closes
  • October 6, 2021: Match Day

Below is a list of supporting documents that must be included with your application, at the time of submission.

Supporting Documents

The following documents must be included to complete your application:

  1. Digital headshot photo (300 dpi).
  2. Curriculum Vitae which includes your educational pedigree, all abstracts, presentations at regional and national meetings, publications, honors, awards and achievements.
  3. Three letters of reference. One letter should be from your residency director. Submit by e-mail at fmigs@aagl.org.
  4. Your residency ACGME case list brief summary (1 page).
  5. Personal statement discussing your interest in pursuing MIGS training (1 page max).
  6. ECFMG certificate (if applicable)
  7. TOEFL IBT certificate (if applicable)
  8. Official copy of USMLE or LMCC transcript
  9. Application payment
  10. If you are currently not a resident in training, provide the following:
    1. A description of your current practice.
    2. A list of all hospital staff and teaching appointments currently held, including types of privileges.
    3. A copy of your malpractice policy.

Eligibility

  • Applicants must have completed a residency in Obstetrics/Gynecology within the United States.
  • The FMIGS match is conducted through the National Residency Matching Program (NRMP). You will be required to register for the match on the NRMP website (https://r3.nrmp.org). 

Why Louisville?

Click the links below for more information about the great places and events in Kentucky

City of Louisville- Louisville is a progressive community of nearly 1 million people.  Many residents live in areas that have the feel of a neighborhood but are conveniently located very close by the hospitals where they work. Situated on the banks of the Ohio River, America's 17th largest city boasts a cost of living that is substantially lower than the national average, with a broad range of affordable housing options from high-rise apartments and historic Victorian homes to suburban communities and rural farms.

Frequently named on "top ten" lists for everything from excellent food to the arts, including a 2019 top 10 city for happiest workers in the U.S. and atop 15 city to where millennials are moving, Louisville offers the amenities of a city but with the welcoming atmosphere of a town.  One of the biggest local attractions in Louisville is its parks system. There are more than 120 public parks in the metro area alone, many created by famed landscape architect Frederick Law Olmstead.  Louisville is the home of the world-famous Kentucky Derby, as well as a variety of other sports activities including an IRONMAN Competition each fall. There are wonderful theaters, music, and galleries, restaurants and food, and festivals that occur throughout the year.  Louisville is home to people from all over the world, creating a community that is very culturally diverse.

Contact

If questions, please contact our Fellowship Administrator:

Dana Lamon

Phone: 502-561-7260

Fax:  502-561-8684