Minimally Invasive Gynecologic Surgery Fellowship

Overview

The Cleveland Clinic Ohio Minimally Invasive Gynecologic Surgery (MIGS) Fellowship is unique in having a core group of nationally and internationally known experts in MIGS. The Section of Minimally Invasive Gynecologic Surgery consists of five gynecologic surgeons, each with complementing areas of surgical expertise, including advanced hysteroscopy, conventional laparoscopy, robotic laparoscopy and vaginal approaches. Our top priority is to educate patients about appropriate treatment options for complex gynecologic pathologies that may include both nonsurgical as well as surgical options. By including a wide of range options, it allows each patient to make the decision that is most appropriate and in line with individual priorities.

The Cleveland Clinic Ohio program prides itself on a robust team of multi-disciplinary colleagues including colorectal surgery, urology, radiology, pathology, psychology, physical therapy, and cardiothoracic surgery to allow optimized care for all patients. An extensive preoperative evaluation is prioritized, as we value the importance of having all required surgeons available at a single surgery. Furthermore, we have a Center for Endometriosis and Chronic Pelvic Pain, as well as Center for Fibroids and Abnormal Uterine Bleeding to allow centered care across specialties.

At the completion of the fellowship, graduates will be able to confidently offer a wide range of nonsurgical and surgical treatment options for complex benign disease. Several surgical approaches will be mastered including hysteroscopy, conventional laparoscopy, robotic and vaginal approaches. Our graduates will also be equipped to excel in performing research, surgical video publication, and implementation of an advanced surgical education curriculum.

Staff

Program Director

Associate Program Director

Cara King, DO

Staff

Teaching Staff

Linda Bradley, MD

Staff

Robert DeBernardo, MD

Section Head, Gynecologic Oncology

Kenneth Edelman, MD

Staff

Miguel Luna, MD

Director of Endometriosis, Ob/Gyn & Women’s Health Institute

Chad Michener, MD

Interim Institute Vice-Chair

Marie Fidela Paraiso, MD

Head, Female Pelvic Medicine & Reconstructive Surgery

Lindsey Valentine, MD

Staff

The Program

The Fellowship in Minimally Invasive Gynecologic Surgery at Cleveland Clinic Ohio is a comprehensive, two-year academic training program incorporating clinical, research and surgical simulation activities. The aim of our fellowship is to graduate competent surgeons trained in a broad spectrum of minimally invasive gynecologic procedures and approaches including conventional laparoscopy, robotic, vaginal and advanced hysteroscopy. Upon completion of our program, our fellows are poised to serve as both scholarly and surgical resources for the communities in which they eventually practice.

Cleveland Clinic Ohio, a not-for-profit, multi-specialty, fully integrated medical center, serves as a leading referral center for complex pathologies and is the primary site of the fellowship activities. We provide outstanding medical diagnosis and treatment for all types of complex illnesses. Common procedures performed by the MIGS faculty include: laparoscopic, robotic and vaginal hysterectomy; laparoscopic, robotic and hysteroscopic myomectomy; excision of endometriosis; surgical treatment of pelvic adhesive disease; mullerian anomalies; pelvic masses; and pelvic pain.

Clinical and surgical experience is offered to the fellows through collaboration of multiple specialties with rotations within female pelvic medicine and reconstructive surgery, radiology, as well as reproductive endocrinology and infertility. Surgical care is performed in collaboration with colorectal surgery, urology, pathology and cardiothoracic surgery when indicated.

Ample protected research time is provided, including four dedicated research blocks. The fellow is expected to complete an independent research project including a systematic review and video abstract, present their research at a national meeting, and publish their results in a peer-reviewed journal before graduating.

Duration

2 years

Evaluations

• Evaluation of fellow includes > 5 procedures per month through myTIPreport platform.
• Milestone evaluation at least twice per year.
• Evaluation of staff and program at least once per year.

Fellowship Experience

Each MIGS fellow will spend a total of six dedicated three‐month blocks (total of 18 months) during the two years of training in the MIGS service, working one‐on‐one with each of the five core MIGS faculty. A fellow will be assigned to rotate through each service to achieve consistent learning and progressive mastery of skills.

In parallel to the Cleveland Clinic mission of patient‐focused care, the fellow will be exposed to a large patient volume in the MIGS referral clinic, Chronic Pelvic Pain and Endometriosis clinic, and Center for Fibroids and Abnormal Uterine Bleeding. Fellows will be in surgery 3‐4 days per week and participate in various office procedures including diagnostic and operative hysteroscopies and trigger point injections, among others. Extensive patient contact under close faculty supervision will allow mastery of understanding the different disease conditions and proficiency in advanced MIGS procedures such as operative hysteroscopy, myomectomy (hysteroscopy, laparoscopy, robotics and mini‐incision), difficult hysterectomy (vaginal, laparoscopy – conventional and single‐incision robotics, and open), adnexectomy, excision of all types of endometriosis, and presacral neurectomy. The goal in the second year of fellowship is for the fellow to function more independently, as Junior Attending, in patient care and residency teaching under the guidance of faculty.

Off‐MIGS Service Rotations

To provide a well‐rounded training in MIGS with a solid foundation in related gynecologic conditions, the fellow will rotate through the Imaging Clinic (both pelvic MRI and ultrasound), REI (including Uterine Transplantation Program), FPMRS/Urogynecology (including Transgender Medicine and Surgery Clinic) and Gynecologic Oncology. Cleveland Clinic Ohio Department of Obstetrics and Gynecology is privileged to have a strong group of nationally and internationally recognized MIGS experts in each of the above subspecialties (Drs. Tommaso Falcone, Marie Fidela Paraiso, Cecile Unger, Chad Michener and Robert DeBernardo). The goal of these rotations is for the fellow to fully comprehend the use of imaging in the diagnosis of benign gynecologic diseases, and understand the relevant reproductive, pelvic floor and oncologic considerations in the management of benign gynecologic conditions. The fellow will also be exposed to complex surgical procedures (including bowel resections and pelvic floor reconstruction) to enhance familiarity with anatomical relationships in pelvic surgery.

Didactics

Weekly didactics include a preoperative gynecology conference, where all MIGS cases are reviewed regarding preoperative work and surgical plan. In addition, the Division of Benign Gynecologic Surgery meets for a monthly journal club, twice monthly core topic review and monthly research updates. A multidisciplinary Benign Gynecology Tumor Board conference is held on the fifth Wednesday of the month and includes faculty from colorectal surgery, REI, pathology and radiology. The Women’s Health Institute meets weekly for various Grand Rounds presentations, M&M and journal club activities.

Research

Cleveland Clinic supports a wide range of research interests with a robust network of resources to equip our leaners with the knowledge to produce meaningful outcomes. Our current projects include evaluation of the role of blood management in surgery for abnormal uterine bleeding, the impact of morbid obesity on minimally invasive procedures, the role of MRI in management of deeply infiltrating endometriosis, and a prospective trial evaluating surgical coaching. We also have IT support for video capture and video editing and narration.

Current Publications

• Dr. Rosanne Kho
• Dr. Mark Dassel
• Dr. Cara King

Benefits

Overview

Approved Time Off

Fifteen (15) vacation days and five (5) personal days are provided at the beginning of each academic year.

Insurance

All clinical trainees at Cleveland Clinic receive medical, dental, vision, prescription, life and short-term disability insurance coverage. Medical insurance is provided with a small premium paid by the resident. Insurance covers residents and their families fully and is effective on the first day of training with no waiting period.

Educational Allowance

The Women’s Health Institute will fund up to $1,500 per year for meeting attendance for fellows that have an abstract or poster accepted for presentation at a national meeting. Meeting attendance does not subtract from vacation days.

Salary

Please refer to the table below for new salary rates, effective April 1, 2019:

Additional Benefits

• Additional information regarding benefits can be viewed on the GME website

How to Apply

Please apply through the AAGL website: https://www.aagl.org/service/fellowships/.

FMIGS programs use The Match via the AAGL.

All applications will be received through the AAGL and ranking will be done in house.