Laparoscopic Pelvic Floor Repair / Sacrocolpopexy

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Please download your Trainee Assessment Documents below. Completed forms are to be emailed to

AGES APS - Laparoscopic Pelvic Floor Repair / Sacrocolpopexy

  • Procedure: Laparoscopic Pelvic Floor Repair / Sacrocolpopexy
  • Please rate the trainee in the domains below using the following scale: N = Not observed or not appropriate, D = Development required, S = Satisfactory standard for completion of this procedure (no prompting or intervention required) or score on the Global Rating Scale
  • Domain
  • Rating N/D/S
  • Comments
  • Communicates appropriately with patient
  • Communicates appropriately with assistant, anaesthetist and theatre staff
  • Demonstrates appropriate pre-operative preparation: institution’s safety check, patient bladder management
  • Demonstrates appropriate operative preparation: patient preparation and positioning, patient bladder management, DVT prophylaxis, IV antibiotics
  • Employs appropriate primary entry technique
  • Employs appropriate secondary port insertion
  • Appropriate vaginal, uterine, and/or rectal manipulation
  • Appropriate intra-operative assessment
  • Employs appropriate respect for tissue
  • Often used unnecessary force on tissue or caused damage by inappropriate use of instrumentsCareful handling of tissue but occasionally caused inadvertent damageConsistently handled tissues appropriately, with minimal damage
  • Demonstrates appropriate time and motion
  • Many unnecessary movesEfficient time and motion, but some unnecessary movesEconomy of movement and maximum efficiency
  • Employs appropriate instrument handling
  • Repeatedly makes tentative or awkward moves with instrumentsCompetent use of instruments, although occasionally appeared stiff or awkwardFluid moves with instruments and no awkwardness
  • Demonstrates appropriate knowledge of instruments
  • Frequently asked for the wrong instrument or used an inappropriate instrumentKnew the names of most instruments and used appropriate instrument for the taskObviously familiar with the instruments required and their names
  • Demonstrates appropriate use of assistants
  • Consistently placed assistants poorly or failed to use assistantsGood use of assistants most of the timeStrategically used assistant to the best advantage at all times
  • Demonstrates appropriate flow of operation and forward planning
  • Frequently stopped operating or needed to discuss next moveDemonstrated ability for forward planning with steady progression of operative procedureObviously planned course of operation with effortless flow from one move to the next
  • Demonstrates appropriate knowledge of specific procedure
  • Deficient knowledge. Needed specific instruction at most operative stepsKnew all important aspects of the operationDemonstrated familiarity with all aspects of the operation
  • Correctly identifies anatomical structures and surgical spaces
  • Recognizes own limitations
  • Manages any complications effectively & efficiently
  • Appropriately completes procedure, closes incisions
  • Devises appropriate post-operative management plan
  • Verbal Feedback is a mandatory component of this assessment.
  • Please use this space to record areas of strength which were highlighted during discussion with the trainee.
  • Please use this space to record suggestions for development which were highlighted during discussion with the trainee.
  • After summarising the discussion with the trainee in the boxes above, please complete the level at which the procedure was performed on this occasion.

    Please note: For a SUMMATIVE ASSESSMENT, the trainee must be assessed as Level 4 "Competent to perform the procedure unsupervised or independently".

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