Minimally Invasive Gynecologic Surgery

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.

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 12 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.

The CREST Program

Fellows may enroll in the Clinical Research Epidemiology and Statistics Training (CREST) program offered by the Department of Epidemiology and Clinical Investigative Sciences located within the School of Public Health at University of Louisville. During the research portion of the fellowship, fellows can complete the coursework which leads to an MSc degree in Epidemiology-Clinical Investigation Sciences.

The CREST curriculum integrates biostatistic and epidemiologic methods in a problem-based learning format with additional instruction in bioethics, health economics, health services, outcomes research, and social-behavior science. CREST is supported by a Clinical Research Curriculum Award (K30) from the National Institute of Health. Fellows may opt for a third year of fellowship to complete the research portion of the program.

The MSc degree program provides physicians an opportunity to acquire the clinical research skills necessary for a career in an academic medicine. For fellows opting to enroll in the MSc program, classes meet in the late afternoons.

Stipends

PGY5: $58,050

PGY6: $60,477

Vacation

20 days + 10 Continuing Health Science Education days

Obstetrics’ Call

1.5 days per month

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.

How to Apply

To apply to our program, please contact:

Department of Obstetrics, Gynecology & Women's Health
University of Louisville School of Medicine
550 S. Jackson Street
Louisville, KY 40202
(502) 561-7463

Fellowship Administrator: Beverly Thompson
E-mail

Contact

Department of Obstetrics, Gynecology & Women's Health
University of Louisville School of Medicine
550 S. Jackson Street
Louisville, KY 40202
(502) 561-7463

Fellowship Administrator: Beverly Thompson
E-mail

Faculty

Faculty members include Resad Paya Pasic, MD, PhD, professor and Director of the minimally invasive gynecologic fellowship and Shan Biscette, MD, assistant professor, Department of Obstetrics, Gynecology, and Women’s Health, the University of Louisville School of Medicine. The two co-directors of the fellowship are clinical faculty members of the department, Jonathan Reinstine, MD, with Associates in OB/GYN, and Lori Warren, MD, with Women First of Louisville.

The MIGS fellowship also collaborates with other subspecialists such as Lynn Parker, MD, gynecologic- oncology; Farid Kehdy, MD, general surgery; Jeffrey Jorden, MD and Kelly Dunn MD, colorectal surgery to increase the scope of the fellowship training experience.

Zhenmin Lei, MD, PhD, professor and interim director of research in the department, mentors fellows research in his laboratories.