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In the Operating Room

RESIDENT EDUCATIONAL PROGRAM AND LIST OF PROCEDURES 2014-2015

The procedures listed below are what each level of house-officer is capable of performing.  All house-officer levels listed below have completed a one-year General Surgery residency.

At the end of each year, the respective HO should be proficient in each of the procedure listed below.  The HOs are evaluated as the year progresses.

HO-2 (URO-1) Objective evaluations are designed on following procedures:

The resident is expected to master basic urologic information including anatomy, physiology, pharmacology, basic diagnostic algorithms including pertinent history, physical, laboratory and diagnostic imaging, techniques, findings and methods of interpretations.  Resident completing the first urologic year will be able to evaluate patients with common urologic complaints such as urologic frequency or flank pain as well as evaluate common urologic presenting signs such as microscopic hematuria.  He or she will be able to manage the care of the pre and post operative urologic patient as well as a gain experience and competence in the outpatient management of common urologic patient problems such as lower urinary tract symptoms in men secondary to bladder outlet obstruction.  These objectives are achieved by clinical rotation to the Tulane University Hospital and Clinics, Medical Center of Louisiana at New Orleans and Southeast Louisiana Veterans Health Care System.

Phallus: dorsal slit; circumcision; biopsy; placement of two piece and three piece inflatable penile prosthesis under supervision.

Urethra: biopsy; meatotomy; excision of caruncle; excision condyloma; extract foreign body; external urethrotomy; internal urethrotomy; and urethral dilation.

Prostate: trans-rectal ultrasound of prostate with needle biopsy; perineal incision and drainage of abscess.

Bladder: punch cystostomy; open cystostomy; cystolithotomy; bladder biopsy and fulguration.

Ureter: Ureterscopy – rigid and flexible; and Holmium laser lithotripsy.

Kidney: ESWL

Scrotal Contents: incision and drainage of abscess; excision of lesion of cord; and excision of skin lesion.

Miscellaneous: hernia repair-inguinal, microscopic urinalysis.

Diagnostic and Endoscopic Procedures: urethroscopy; rigid and flexible cystoscopy; ureteral catheterization; ureteral catheterization with pyelogram; ureteral catheterization stent placement - differential function; pyelogram, intravenous  pyelogram, percutaneous  nephrostogram; loop-o-gram; cine-pyelogram; urethrogram - retrograde; cystogram; cystourethrogram; and cystometrogram, Transrectal ultrasound and prosthesis biopsy  (ureteroscopy ± biopsy, Holmium laser lithotripsy and stone basketing, nephroscopy ± biopsy with Holmium laser lithotripsy and ultrasonic lithotripsy - depending on the proficiency of the resident.) Assistant at urologic laparoscopic procedures; Bedside assistants for robotic da Vinci procedures including radical prostatectomy, pyeloplasty, partial nephretomy

Adrenal: None

HO-3 (URO-2) Objective evaluations are designed on following procedures:

The resident is provided with sufficient exposure to didactic lectures and basic research to result in an understanding of facility in evaluation of current information, formulation of questions that are answerable by experiment.  The principles of study design, the methodology of basic science and clinical investigation are the analysis and reporting of results.  The resident gains ability to participate in clinical trials and to evaluate reports of new technology and the implications of basic science finding as they may translate to clinical utility in the future.  The resident gains experience in the management of pediatric patients at Children’s Hospital.  He or she gains a sophisticated level of understanding of pediatric urology congenital abnormalities and diseases.  The resident refines the skills needed for initial evaluation and consultation of pediatric urology patients and the management of laboratory and diagnostic imaging techniques as well as management of the pre and post operative care.

Phallus: dorsal slit; circumcision; excision of tumor/cyst; biopsy; and repair injury, placement of semi rigid and inflatable penile prosthesis under supervision.

Urethra: biopsy; meatotomy; excision of caruncle; drainage of urinary extravasation; diverticulectomy - male; diverticulectomy - female; excision condyloma; extract foreign body; external urethrotomy; and internal urethrotomy.

Prostate: laser prostatectomy (Greenlight and Revolix) trans-rectal ultrasound of prostate with needle biopsy; endoscopic incision and drainage of abscess; perineal incision and drainage of abscess; prostatectomy - transurethral; prostatectomy - retropubic, simple; prostatectomy - suprapubic; and prostatectomy - transvesico-capsular.

Bladder: punch cystostomy; open cystostomy; cystolithotomy; litholapaxy; electrohydraulic lithotripsy; repair of rupture; bladder tumor resection, endoscopic; bladder tumor biopsy, endoscopic; diverticulectomy; bladder neck incision - endoscopic; bladder neck revision - open; Marshall Marchetti; anterior vaginal repair; pereyra procedure; sling procedure; and Leadbetter procedure.

Ureter: rigid and flexible ureteroscopy biopsy, endoscopic; open biopsy; repair ureterocele; meatomy, endoscopic; cystourethroscopy ureteral calculus manipulation; and Holmium laser lithotripsy.

Kidney: exploration; needle biopsy; open biopsy; drainage of peri-renal abscess; percutaneous nephroscopy; percutaneous nephroscopy - calculus extraction; percutaneous nephroscopic lithotripsy, and laparoscopic procedures.

Scrotal Contents: incision and drainage of abscess; excision of lesion of cord; hydrocele; excision of lesion of tumor; vas ligation; epidiymotomy; epididymectomy; hydrocelectomy; spermatocelectomy; reduction, torsion testicle; excision, torsion hydatid; excision, lesion of tunica vaginalis; excision lesion of testic; orchiectomy, simple; repair injury to testis; insert testicular prosthesis; and excision of skin lesion.

Miscellaneous: hernia repair-inguinal; hernia repair-lumbar; hernia repair-ventral; exploratory laparotomy; closure of evisceration; inguinal lymphadenectomy, superficial; and pelvic lymphadenectomy.

Diagnostic and Endoscopic Procedures: urethroscopy; cystoscopy; ureteral catheterization; ureteral catheterization with pyelogram; ureteral catheterization - differential function; ureteroscopy and biopsy ± Holmium laser lithotripsy, stone basketing; pyelogram; intravenous pyelogram; percutaneous; nephrostogram; percutaneous nephrostomy placement; loop-o-gram; cine-pyelogram; urethrogram - retrograde; cystogram; cystourethrogram; vasogram; cystometrogram; ureteral pressure profile; Whittaker test - percutaneous; Whittaker test - open; cavernosogram, percutaneous access for kidney stones, and urologic laparoscopic procedures (renal cyst decortications, nephrectomy, etc.) (Laparoscopy and robotic and associated procedures - depending on the proficiency of the resident.)

Adrenal: None

HO-4  (URO-3) Objective evaluations are designed on following procedures:

In the third urologic year, there are three major educational objectives.  The first is to enhance the coordination and implementation of longitudinal evaluation and management of urological adult patients through ambulatory and inpatient settings.  The goal includes mastery of urologic procedures essential to office based practice including cystoscopy, vasectomy, ultrasonography (transrectal, as well as abdominal, pelvic and scrotal) and shock wave lithotripsy, interpretation of uroflow and urodynamics.   The second educational objective is to train the residents to master the necessary skills for the provision of consultative services including evaluation and management of inpatients and outpatients but additionally to communicate effectively with medical colleagues.

Phallus: dorsal slit; circumcision; excision of tumor/cyst; biopsy; partial amputation; complete amputation; insert non-inflatable, semi-rigid prosthesis; insert non-inflatable, rigid prosthesis; insertion of inflatable, single-unit prosthesis; excision of fibrosis corpora; chordelysis;  repair injury and manage Peyronie's disease

Urethra: biopsy; meatotomy; excision of caruncle; repair injury; drainage of urinary extravasation; hypospadias repair; microsurgical closure of fistula; partial excision; urethrectomy; diverticulectomy - male; diverticulectomy - female; excision condyloma; extract foreign body; external urethrotomy; internal urethrotomy; and urethroplasty.

Prostate: trans-rectal ultrasound of prostate with needle biopsy; open biopsy; endoscopic incision and drainage of abscess; perineal incision and drainage of abscess; prostatolithotomy; prostatectomy - transurethral; prostatectomy - retropubic, simple; prostatectomy - retropubic, radical; prostatectomy - suprapubic; prostatectomy – perineal transvesico-capsular.  (Robotic prostatectomy - depending on the proficiency of the resident.)

Bladder: punch cystostomy; open cystostomy; cystolithotomy; litholapaxy; electrohydraulic lithotripsy; repair of rupture; cystostomy for electrocoagulation; bladder tumor resection, endoscopic; bladder tumor biopsy, endoscopic; cystectomy, partial; cystectomy, radical; cystectomy, simple; diverticulectomy; cystoplasty ileum; cystoplasty sigmoid; cystoplasty cecum; cystoplasty ileocecal; cystoplasty vesicostomy; cystoplasty repair of fistula - vesico cutaneous; cystoplasty repair of fistula - vesico sigmoid; cystoplasty repair of fistula - vesico rectal; cystoplasty repair of fistula - vesico vaginal; bladder neck revision - endoscopic; bladder neck revision - open; Marshall Marchetti; anterior vaginal repair; pereyra procedure; sling procedure; and Leadbetter procedure.  (Robotic Radical Cystectomy - depending on the proficiency of the resident – Bedside and console surgeon)

Ureter: biopsy, endoscopic; open biopsy; repair ureterocele; meatomy, endoscopic; open repair, ureterocele; ureterolithotomy; ureteral repair - lysis; ureteral repair; ureteral repair - rectrocaval ureter; ureteral repair - ureteroneocystostomy, simple; ureteral repair - ureteroneocystostomy, ureteroplasty; ureteral repair - excision and anastomosis; ureteral repair - ureteroplasty; ureteral repair - uretero-ureterostomy; ureteral repair - uretero-calyceal anastomosis; ureteral repair - close uretero vaginal fistula; ureteral repair - close uretero intestinal fistula; uretero-enterostomy: ileal conduit; uretero-enterostomy: colon conduit; uretero-enterostomy: ureterosigmoidostomy; uretero-enterostomy: ileocecal pouch; uretero-enterostomy: ileocecal conduit; ureteroscopic tumor biopsy; * ureteroscopic tumor removal; ureteroscopic stone extraction; ureteroscopic lithotripsy; cystourethroscopy ureteral calculus manipulation; and cystourethroscopy ureteral calculus extraction, and endoureterotomy

Kidney: exploration; repair of trauma; needle biopsy; open biopsy; drainage of peri-renal abscess; drainage of renal abscess; nephrostomy; pyelostomy; nephropexy; denervation of pedicle; closure of renal fistula; nephrolithotomy; abdominal transperitoneal nephrectomy; extra peritoneal nephrectomy; partial nephrectomy; nephro-ureterectomy; nephroureterectomy with partial cystectomy; excision or decortication of cyst; pyeloureteroplasty; percutaneous nephroscopy; percutaneous nephroscopy - calculus extraction; percutaneous nephroscopy lithotripsy, and Laparoscopy for all renal procedures (includes: Robotic Partial Nephrectomy, Robotic Pyeloplasty, Laparoscopic Nephrectomy, Laparosocopic nephro-ureterectomy).

Scrotal Contents: incision and drainage of abscess; excision of lesion of cord; hydrocele; excision of lesion of tumor; vas ligation; epidiymotomy; epididymectomy; microscopic ligation spermatic veins; macroscopic ligation spermatic veins; microscopic vaso-vasotomy; vaso-epididostomy; macroscopic vaso-vasotomy; hydrocelectomy; spermatocelectomy; reduction, torsion testicle; excision, torsion hydatid; excision, lesion of tunica vaginalis; excision lesion of testis; orchiectomy, simple; orchiectomy, radical; orchiotomy; repair injury to testis; testis biopsy; insert testicular prosthesis; and excision of skin lesion.

Miscellaneous: hernia repair-inguinal; hernia repair-lumbar; hernia repair-ventral; exploratory laparotomy; pelvic exenteration, anterior; pelvic exenteration, complete; biopsy retroperitoneal tumor; colostomy; closure of evisceration; inguinal lymphadenectomy, superficial; inguinal lymphadenectomy, deep; pelvic lymphadenectomy; and gastrostomy tube placement.

Diagnostic and Endoscopic Procedures: urethroscopy; cystoscopy; ureteroscopy; nephroscopy; ureteral catheterization; ureteral catheterization with pyelogram; ureteral catheterization - differential function; pyelogram, intravenous; pyelogram, percutaneous; nephrostogram; nephromogram; percutaneous nephrostomy placement; loop-o-gram; cine-pyelogram; urethrogram - retrograde; cystogram; cystourethrogram; renal cystogram; percutaneous renal cystogram; cystometrogram; ureteral pressure profile;  Fluorourodynamics; Whittaker test - percutaneous; Whittaker test - open; and cavernosogram, urologic laparoscopy; percutaneous renal access; and robotic da Vinci procedures (bedside and console).

Adrenal: exploration; excision of cyst; adrenalectomy or partial adrenalectomy; and adrenalectomy, bilateral.  Laparoscopic adrenalectomy.

 HO-5 (URO-4) Objective evaluations are designed on following procedures:

During Urology year 4, the Chief Residency year, the resident acquires skill in the supervision of Junior residents, develops further skill in the teaching of junior residents and masters the most advanced and sophisticated urologic procedures.  During this year, the resident gains organizational skill needed to be an effective leader and administrator.  At the conclusion of the year, the resident is well versed in the responsibilities of clinical practice both inpatient and outpatient services and will have the competence needed to succeed in his or her future endeavors.  Residents will learn responsibility of leadership as Chief Resident at each campus.  Under faculty supervision they will run the inpatient urology service as well as weekly outpatient clinic.  They will gain responsibility in complex open, Laparoscopic and Robotic urologic procedures.  By the completion of the 4th year of urology training, our residents should be prepared to take the examination for Board certification and to assume his or her place as a member of the urology profession.

Phallus: dorsal slit; circumcision; clitorectomy; excision of tumor/cyst; biopsy; partial amputation; complete amputation; insert non-inflatable, semi-rigid prosthesis; insert non-inflatable, rigid prosthesis; insertion of inflatable, single-unit prosthesis; insertion of inflatable, triple-unit prosthesis; excision of fibrosis corpora; chordelysis; repair injury; and Peyronie's disease.

Urethra: biopsy; meatotomy; excision of caruncle; repair injury; drainage of urinary extravasation; hypospadias repair; macrosurgical closure of fistula; microsurgical closure of fistula; partial excision; urethrectomy; diverticulectomy - male; diverticulectomy - female; urethrolithotomy; excision condyloma; extract foreign body; external urethrotomy; internal urethrotomy; urethroplasty; repair urethro-vaginal fistula; repair transpubic injury; repair suprapubic injury; and repair perineal injury.
Prostate: trans-rectal ultrasound of prostate with needle biopsy; open biopsy; endoscopic incision and drainage of abscess; perineal incision and drainage of abscess; repair of recto-urethral fistula; prostatolithotomy; prostatolithotomy  - perineal; prostatolithotomy - suprapubic; prostatolithotomy - endoscopic; prostatectomy - transurethral; prostatectomy - cryosurgical; prostatectomy - retropubic, simple; prostatectomy - retropubic, radical, laparoscopic radical prostatectomy; prostatectomy - simple perineal; prostatectomy - radical perineal; prostatectomy - simple parasarcal; prostatectomy - radical parasarcal; prostatectomy - suprapubic; prostatectomy – perineal, transvesico-capsular; (Robotic radical prostatectomy) urologic laparoscopy (all procedures)

Bladder: punch cystostomy; open cystostomy; cystolithotomy; litholapaxy; electrohydraulic lithotripsy; repair of rupture; cystostomy for tumor excision; cystostomy for electrocoagulation; bladder tumor resection, endoscopic; bladder tumor biopsy, endoscopic; cystectomy, partial; cystectomy, radical; cystectomy, complete laparoscopic cystectomy; diverticulectomy; cystoplasty ileum; cystoplasty sigmoid; cystoplasty cecum; cystoplasty ileocecal; cystoplasty vesicostomy; cystoplasty repair of exstrophy; cystoplasty repair of fistula - vesico cutaneous; cystoplasty repair of fistula - vesico sigmoid; cystoplasty repair of fistula - vesico rectal; cystoplasty repair of fistula - vesico vaginal; bladder neck revision - endoscopic; bladder neck revision - open; insert artificial sphincter for incontinence; Marshall Marchetti; anterior vaginal repair; pereyra procedure; sling procedure; Leadbetter procedure; ileal conduit; neo-bladder and  Indiana pouch urinary reservoir.

Ureter: biopsy, endoscopic; open biopsy; repair ureterocele; meatotomy, endoscopic; open repair, ureterocele; ureterolithotomy; ureteral repair - lysis; ureteral repair - excision of ovarian lesion; ureteral repair - rectrocaval ureter; ureteral repair - ureteroneocystostomy, simple; ureteral repair - ureteroneocystostomy, ureteroplasty; ureteral repair - excision and anastomosis; ureteral repair - ureteroplasty; ureteral repair - uretero-ureterostomy; ureteral repair - uretero-calyceal anastomosis; ureteral repair - close uretero vaginal fistula; ureteral repair - close uretero intestinal fistula; ureterotomy for tumor; ureterotomy - partial; ureterotomy - complete; ureterostomy - in situ; ureterostomy cutaneous; uretero-enterostomy: ileal conduit; uretero-enterostomy: colon conduit;uretero-enterostomy: ureterosigmoidostomy; uretero-enterostomy: rectal bladder and sigmoid pull through; uretero-enterostomy: ileocecal pouch; uretero-enterostomy: ileocecal conduit; uretero-enterostomy: Koch pouch; uretero-enterostomy:Camay procedures; ureteroscopic tumor biopsy;
ureteroscopic tumor removal; ureteroscopic stone extraction; ureteroscopic lithotripsy; cystourethroscopy ureteral calculus manipulation; and cystourethroscopy ureteral calculus extraction.  Laparoscopic procedures on ureters.

Kidney: exploration; repair of trauma; needle biopsy; open biopsy; drainage of perineal abscess; drainage of renal abscess; nephrostomy; pyelostomy; nephropexy; denervation of pedicle; closure of renal fistula; close reno-intestinal fistula; nephrolithotomy; abdominal transperitoneal nephrectomy; extra peritoneal nephrectomy; lumbar nephrectomy; thoraco-abdominal nephrectomy; partial nephrectomy; calycectomy; nephro-ureterectomy; nephroureterectomy with partial cystectomy; infundibuloplasty; excision or decortication of cyst (laparoscopic approach to these procedures); symphsiotomy; pyeloureteroplasty; renal vascular surgery; renal bench surgery; percutaneous nephroscopy; percutaneous nephroscopy - calculus extraction; and percutaneous nephroscopic lithotripsy.  All kidney laparoscopic procedures.

Scrotal Contents: incision and drainage of abscess; excision of lesion of cord; hydrocele; excision of lesion of tumor; vas ligation; epidiymotomy; epididymectomy; microscopic ligation spermatic veins; macroscopic ligation spermatic veins; microscopic vaso-vasotomy; macroscopic vaso-vasotomy; hydrocelectomy; spermatocelectomy; reduction, torsion testicle; excision, torsion hydatid; excision, lesion of tunica vaginalis; excision lesion of testis; orchiectomy, simple; orchiectomy, radical; orchiotomy; repair injury to testis; testis biopsy; insert testicular prosthesis; and excision of skin lesion.

Miscellaneous: hernia repair-inguinal; hernia repair-lumbar; hernia repair-ventral; exploratory laparotomy; pelvic exenteration, anterior; pelvic exenteration, complete; biopsy retroperitoneal tumor; excision of retroperitoneal tumor; retroperitoneal node dissection; colostomy; closure of evisceration; inguinal lymphadenectomy, superficial; inguinal lymphadenectomy, deep; pelvic lymphadenectomy; and gastrostomy tube placement.

Diagnostic and Endoscopic Procedures: urethroscopy; cystoscopy; ureteroscopy; nephroscopy; ureteral catheterization; ureteral catheterization with pyelogram; ureteral catheterization - differential function; pyelogram, intravenous; pyelogram, percutaneous; nephrostogram; nephromogram; percutaneous nephrostomy placement; loop-o-gram; cine-pyelogram; urethrogram - retrograde; cystogram; cystourethrogram; cystometrogram; ureteral pressure profile; Whittaker test - percutaneous; Whittaker test - open; and cavernosogram, all diagnostic and therapeutic urologic laparoscopic procedures on kidney, ureter, bladder - intra-abdominal; Fluorourodynamics; Whittaker test - percutaneous; Whittaker test - open; and cavernosogram, urologic laparoscopy; percutaneous renal access; and robotic da Vinci procedures (bedside and console).

Adrenal: exploration; excision of cyst; open and laparoscopic adrenalectomy or partial adrenalectomy; adrenalectomy, bilateral; and radical adrenalectomy.

 

Tulane University, New Orleans, LA 70118 504-865-5000 website@tulane.edu