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Essentials in Minimally Invasive Gynecology (EMIG Didactic)

AAGL has developed NEW educational materials, “Essentials in Minimally Invasive Gynecology (EMIG) Didactic Program” to assist practicing physicians and subspecialty fellows in the performance of basic and advanced endoscopic surgery.

This 12-module EMIG Didactic program will help you better understand and learn the fundamentals of endoscopic surgery and minimum standards for cognitive and technical principles used in performing endoscopic gynecologic procedures.

AAGL is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AAGL designates this enduring material for a maximum of 10.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

For immediate access, click the button below to purchase the program. Once you have purchased the program, a confirmation and link will be sent to you to access the program on AAGL’s educational content website.

AAGL Member Price $375

Current AAGL Members receive this program at substantially discounted rates!

NON-Member Price $725

Non-Member Pricing includes one year membership in the AAGL, including access to the JMIG (Journal on Minimally Invasive Gynecology), SurgeryU and the ListServ.

Please click the “+” sign on the table below to view the training highlights for each module.

Module 1: General Endoscopic Principles

Faculty: Nicole M. Donnellan, MD, Gaby N. Moawad, MD, Christopher C. DeStephano, MD, MPH, Sarah L Cohen, MD, MPH, Sangeeta Senapati, MD, Matthew Hopkins, MD, Megan N. Wasson, DO

AAGL designates this enduring material for a maximum of .75 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Module 1 training highlights

Diagnosis and Management of Postoperative Complications – Cardiopulmonary
General Perioperative Management – Preoperative
Principles of Equipment, Tissue Extraction and Energy Sources – Bleeding, Benign Adnexal Masses and Benign Uterine Conditions
Hysteroscopic Procedures – Indications/contraindications
Operative Laparoscopy – Indications/Contraindications
Neoplasia – Suspected and Unsuspected (ovarian/uterine/cervical-sections)
Hemodynamically unstable patient
Appropriateness for laparoscopic surgery
Appropriateness for hysteroscopic surgery
Surgical options for adnexal mass
Evaluation and management of the patient with complex medical history
Assessing patients with abnormal uterine bleeding – assess risk pre-ablation, pre-hysterectomy or other high-risk characteristics

Module 2: Principles of Applied Anatomy and Physiology

Faculty: Amy N Broach, MD, MS, Jordan Klebanoff, MD, Sangeeta Senapati, MD, Sarah L. Cohen, MD, MPH, Megan N. Wasson, DO

Module 2 training highlights:

Anatomy of the pelvis and abdomen
Anatomy pertaining to hysteroscopic procedures
Anatomy pertaining to laparoscopic procedures
Description of the course of the ureter at different levels
Description of the pelvic floor support
Management of an injury to the bladder trigone and consequences of the repair
Appropriate management of a functional cyst found during laparoscopy

Module 3: Instrumentation

Faculty: Sangeeta Senapati, MD, Sarah L. Cohen, MD, MPH, Hye-Chun Hur, MD, MPH, Christopher C. DeStephano, MD, MPH, Nicole M. Donnellan, MD, Adela Cope, MD, Megan N. Wasson, DO

AAGL designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Module 3 training highlights:

Principles of Equipment, Tissue Extraction and Energy Sources
Operative Laparoscopy – Surgical Technique
The utility of the angled scope
Risk factors for thermal injury during laparoscopy
Optimizing your laparoscopic image
Improving visualization during hysteroscopy
Managing the intra-uterine pressure
Reducing risk of injury when using uterine manipulators
Characteristics of CO2 that make it ideal for laparoscopic procedures
Minimizing fluid absorption
Appropriate pairing of the energy modality and the distention medium

Module 4: Energy Sources

Faculty: Malcom G. Munro, MD, FACOG, FRCSC, Megan N. Wasson, DO

AAGL designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Module 4 training highlights:

Principles of Equipment and Energy Sources
Electrosurgical principles including generator output and relative risks
Electrosurgical tissue effects
Principles of energy instrumentation
Factors affecting the quality of the vessel occlusion with a bipolar device
Potential complications – direct and capacitive coupling
Principles of ultrasonic technology and clinical applications

Module 5: Operating Room Set Up and Patient Positioning

Faculty: Sarah L. Cohen, MD, MPH, Megan N. Wasson, DO

AAGL designates this enduring material for a maximum of .25 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Module 5 training highlights:

General Perioperative Management – Intraoperative
Diagnosis and Management of Postoperative Complications – Neurologic
Identifying errors in patient positioning
Identifying ergonomic issues and potential risks

Module 6: Principles of Operative Laparoscopy

Faculty: Matthew Hopkins, MD, Nicole M. Donnellan, MD, Amy N. Broach, MD, MS, Sarah L. Cohen, MD, MPH, Sangeeta Senapati, MD, Megan N. Wasson, DO

Module 6 training highlights:

Principles of Equipment, Tissue Extraction and Energy Sources
Operative Laparoscopy – Surgical Technique
Pneumoperitoneum – Troubleshooting
Assessing safe laparoscopic entry
Alternate site primary laparoscopic entry
Risk factors for primary entry complications
The factors contributing to the need for fascial closure
Avoiding injury to the vessels and nerves relating to lateral ports
Landmarks for safe laparoscopic entry with different BMIs
Alternate primary laparoscopic entry in patient with previous midline laparotomy of primary entry complications
Safety principles of laparoscopic tissue extraction
Appropriate needle/suture selection for laparoscopic suturing
Risk factors for adhesions

Module 7: Principles of Operative Hysteroscopy

Faculty: Sarah L. Cohen, MD, MPH, Jordan Klebanoff, MD, Christopher C. DeStephano, MD, MPH, Megan N. Wasson, DO

AAGL designates this enduring material for a maximum of .50 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Module 7 training highlights:

Hysteroscopic Procedures – Surgical Technique and Fluid Management
Dosing of local anesthetics, techniques and risks
Agents used for cervical preparation for pre-menopausal women
Anatomic landmarks for hysteroscopic entry
Recognizing and managing uterine perforation during hysteroscopy
Benefits and risks of cervical vasopressin injections
Distention media with bipolar and monopolar energy
Safe techniques for using the resectoscope in different regions of the uterus

Module 8: Laparoscopic Procedures

Faculty: Sangeeta Senapati, MD, Jordan Klebanoff, MD, Sarah L. Cohen, MD, MPH, Gaby N. Moawad, MD, Amy N. Broach, MD, MS, Megan N. Wasson, DO

Module 8 training highlights:

Acute, Chronic, Benign Adnexal Masses and Benign Uterine Conditions
Diagnosis and Management of Postoperative Complications – Genitourinary
Operative Laparoscopy – Procedures
Hysterectomy – Complications
Total Laparoscopic (TLH) – Complications
Laparoscopic-assisted vaginal (LAVH) – Complications
Vaginal (VH) – Complications
Neoplasia – Suspected and Unsuspected (ovarian/uterine/cervical-sections)
Lysis of adhesions – Safety
Laparoscopic management and follow-up of ectopic pregnancy
Surgical steps for laparoscopic management of adnexal masses
Principles of safe laparoscopic oophorectomy – adnexal mass adhering to the pelvic sidewall
Management options for young women with ovarian torsion
Complications of myomectomy
Minimizing the risk of ureteral injury during hysterectomy
Indications and contraindications to supra-cervical hysterectomy
Principles to minimize recurrent pain and recurrent cysts in patients with ovarian endometrioma

Module 9: Hysteroscopic Procedures

Faculty: Amy N. Broach, MD, MS, Jordan Klebanoff, MD, Gaby N. Moawad, MD, Sangeeta Senapati, MD, Megan N. Wasson, DO

Module 9 training highlights (drop down):

Principles of Equipment, Tissue Extraction and Energy Sources – Benign Uterine Conditions
Hysteroscopic Procedures
Diagnostic options for focal or diffuse pathology
Endometrial ablation risks that should be discussed the patient
Management of uterine fibroids
Appropriate technique for hysteroscopic polypectomy

Module 10: Laparoscopic Complications

Faculty: Gaby N. Moawad, MD, Nicole M. Donnellan, MD, Amy N. Broach, MD, MS, Stacey A. Scheib, MD, FACOG, Sangeeta Senapati, MD, Jordan Klebanoff, MD, Megan N. Wasson, DO

AAGL designates this enduring material for a maximum of 2.25 AMA PRA Category 1 Credit(s)™. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Module 10 training highlights:

General Perioperative Management – Intraoperative and Postoperative
Diagnosis and Management of Postoperative Complications – Hemorrhage, Gastrointestinal, Genitourinary,
Cardiopulmonary and Neurologic
Operative Laparoscopy – Complications
Hysterectomy – Complications
Total Laparoscopic Hysterectomy (TLH) – Complications
Laparoscopic-assisted vaginal (LAVH) – Complications
Vaginal (VH) – Complications
Managing injury – patient having a cystoscopy and a hysterectomy and only one ureteric jet seen
Managing injury – entry injury in the retroperitoneum
Managing injury – secondary port entry injury
Managing injury – injury to small bowel at entry or during surgery
Evaluating bowl integrity with severe endometriosis involving the rectum
Identifying intraoperative or post-operative signs of bladder injury
Common areas of injury in laparoscopic procedure
Managing patients who become asystolic/bradycardic during surgery
Managing patients with a major vascular intraoperative injury
Management strategy for patient with thermal bowel injury
Next steps for a patient becoming hemodynamically unstable at entry or during the surgery
Identification of workup, management and diagnosis of various scenarios
Identification of risks and preventative measures for port-site hernia
Identification of vaginal cuff complications from laparoscopic hysterectomy
Identification of factors that my decrease the chances of vaginal cuff dehiscence
Identification of the injured nerve in a neurological presentation

Module 11: Hysteroscopic Complications

Faculty: Nicole M. Donnellan, MD, Christopher C. DeStephano, MD, MPH, Gaby N. Moawad, MD, Jordan Klebanoff, MD, Megan N. Wasson, DO

Module 11 training highlights (drop down):

General Perioperative Management – Intraoperative and Postoperative
Hysteroscopic Procedures – Fluid Management and Complications (intraoperative and postoperative)
Management for patients with excessive hypotonic solution absorption
Management of bleeding for patients with significant bleeding during hysteroscopy
Management strategy for patients with perforation at myomectomy with an active electrode
Management of patients having a vasovagal or allergic reaction during an office hysteroscopy
Management of complications of endometrial ablation

Module 12: Special Considerations

Faculty: Nicole M. Donnellan, MD, Christopher C. DeStephano, MD, MPH, Gaby N. Moawad, MD, Jordan Klebanoff, MD, Megan N. Wasson, DO

Module 12 training highlights:

General Perioperative Management – Preoperative and Intraoperative
Surgical principles for patients with elevated BMI
Consideration of laparoscopy on pregnant patients
Consideration of laparoscopy on patients with comorbidities

Special thanks to Megan Wasson, DO and Isabel Green, MD, Current and Former EMIG Didactic Chairs, respectively, and the following members of AAGL listed below who have been involved in the educational planning of this activity.

EMIG Content Planners:
Amy N. Broach, MD, MPH, Sarah L. Cohen, MD, MPH, Adela G. Cope, MD, Christopher C. Destephano, MD, MPH, Nicole M. Donnellan, MD, Isabel C. Green, MD, Matthew R. Hopkins, MD, Hye-Chun Hur, MD, MPH, Jordan Klebanoff, MD, Gaby N. Moawad, MD, Malcolm G. Munro, MD, FACOG, FRCSC, Stacey A. Scheib, MD, FACOG, Sangeeta Senapati, MD, Maria Victoria Vargas, MD, Megan Wasson, DO