Minimally Invasive Gynaecologic Surgery (MIGS)

Program Director: 
Dr. Deborah Robertson
Staff, Department of Obstetrics & Gynaecology, St. Michael's Hospital 
Professor, Department of Obstetrics & Gynaecology, University of Toronto 

Contact: 
Janet Forrest
Tel: (416) 864-5384 
Email: forrestja@smh.ca

Site: St. Michael's Hospital

Application Deadline: Submit Application Form by August 1st of each year (to start July 1st in the following year). 

Program Information 

With the rapid evolution of Obstetrics and Gynaecology it is difficult for residents to obtain expertise in the more advanced pelvic surgery. This fellowship is intended to offer a concentrated exposure to gynecologic surgery including advanced vaginal surgery, pelvic reconstruction and endoscopic procedures. The fellow will be under direction of the Division of Gynecologic Surgery in the Department of Obstetrics and Gynecology at St. Michael's Hospital and will work in close affiliation with the other members of the Minimally Invasive Surgery Program.

The 24-month program will consist of 60% clinical work and 40% basic science education and research. The time will be allotted based on the operating room schedule and will contain a minimum of three operating days weekly when on clinical service. In the first trimester, the fellow will be expected to develop a research project to be completed during the year. A 6-8 week elective may be organized in another institution at the discretion of the fellow and supervisor.
The gynecologic surgery fellowship entails being responsible for the supervision of weekly gynecologic surgical rounds (reviewing gynecologic surgical morbidity, interesting cases and points of debate), keeping a logbook of cases to be reviewed with the supervisor, and taking part in the schedule to supervise the resident gynaecologic clinic and be responsible for teaching residents and assist at planned surgeries. Another aspect of the fellowship will entail taking calls from home for surgical emergencies and being available to come in when required to manage the gynaecologic surgery cases. Lastly, a completion of a post-graduate degree (ie. Master's of education, clinical epidemiology) is expected during this 2-year fellowship. 

Objectives 

During the 24-month fellowship, the gynecologist will develop a solid foundation for the management of more complex gynecological surgical procedures including:

  • Pre-operative assessment of the patient, indications for surgery and choice of surgical approach; 
  • Management of pelvic floor relaxation; 
  • Endometriosis; conservative and definitive operative management; 
  • Principles of endoscopy, electrosurgery and laser; 
  • Anatomy of the retropertioneum, pelvic node dissection and management of the pelvic mass; 
  • Peri-operative complications: prevention, recognition and management; 
  • Minimally Invasive Surgical approaches to hysterectomy, advanced endometriosis and other pelvic pathologies.

In order to fulfil the objectives, the fellow will be encouraged to attend basic anatomy and endoscopy laboratories, participate in the pre-operative work-up of the patients, take an active role in the post-operative care and perfect surgical skills in the operating room.

The Setting: St. Michael's Hospital 

The fellowship is based primarily at St. Michael's Hospital, however, the endoscopic training could involve the Minimal Access Surgery lab, and basic anatomy review may take place at University of Toronto Medical School. A 6-8 week elective may be based at another hospital site either in or outside Toronto at the discretion of the Chief of Obstetrics and Gynecology at St. Michael's Hospital. The fellow will have opportunity to work closely with other departments including general surgery, pathology, urology, and anesthesia.

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