Fellowship in Advanced Laparoscopy & Pelvic Pain

History
Application Process
Training Objectives
Curriculum
Research 

Fellowship History

Over the past 15 years, the Division has gained regional and national recognition for its efforts to provide the best of advanced laparoscopic surgery for women and pelvic pain management. As part of a major academic medical center, the Division excels in training, research and clinical programs. Our dual purpose is to train those who will provide top quality patient care and be the academic leaders in gynecologic laparoscopy and pelvic pain management, who in turn will train many physicians for practice in communities across the country. This emphasis makes our fellowship one of the most unique programs in the United States .

The Division offers a two-year Fellowship in Advanced Laparoscopic Surgery and Pelvic Pain, designed to begin after completion of the standard four-year United States residency in obstetrics and gynecology. As of 2007, our program participates in the fellowship matching program administered by the American Association of Gynecologic Laparoscopists (AAGL). Our fellowship began in 1998, and is one of only two two-year fellowship programs in gynecologic laparoscopy in the United States. Our purpose is to train academic physicians who will become leaders in the teaching, research, and practice of operative gynecologic laparoscopy and the management of chronic pelvic pain problems.fellowship

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Clinical Training

As a division within the Department of Obstetrics and Gynecology, we perform over 400 surgeries per year. About 700 new patients are seen annually, along with over 3600 return visits. Patients are referred from gynecologists and primary care physicians in North Carolina and from throughout the southeast portion of the United States . A growing number of patients are self-referring after learning of our experience with laparoscopic surgery from physicians, friends, or the Internet. As a result, residents and fellows in training in obstetrics and gynecology at the University of North Carolina receive a level of laparoscopic training far above the average university medical center in the United States .

Graduating fellows are proficient in all aspects of gynecologic laparoscopic surgery, including: complicated hysterectomies (both supra-cervical and complete), and both conservative and definitive surgery for advanced stages of endometriosis. The Fellow participates in his/ her own operative cases and also serves as attending physician for resident surgery cases.

Pain management is taught in closely mentored clinical settings, and is influenced by relationships with the pain management programs in other departments at the University of North Carolina, such as the Anesthesia Pain Clinic, the Neurology Pain Clinic, and the Dental Pain Clinic.

Research Training

The fellow selected to begin in July, 2008, will also enroll in the Masters in Clinical Investigation (MCI) program in the UNC School of Public Health. This program will provide core courses in statistics and research design, and advanced topics in proposal development that will be coordinated with our Division’s interests and goals. Fellows will complete the bulk of the class work in the first year. The schedule of the program will allow ample time for clinical training as well.

From 1998-2006, seven of the nine fellows completed an epidemiologically based Masters in Public Health degree. As that program evolved, course requirements increased to the point of placing unrealistic demands upon our fellows, who had substantially more clinical responsibilities than other MPH candidates. For that reason, we revised our program to have fellows participate in the MCI program instead. Fellows finishing our program will have the option of continuing work toward an MPH if they wish.

As an outgrowth of this research training, each fellow completes a research project suitable for publication during the second year of the program. Mentorship for this project comes from Denniz Zolnoun, MD, MPH, in our Division; Jane Leserman, PhD, an experienced clinical researcher who spends 20% time in our division; and faculty and staff of the Women’s Health Research Program, which is led by faculty in Obstetrics and Gynecology.

The ultimate aims of the fellowship are to add to the group of physicians who play a major role in teaching advanced gynecologic laparoscopy in the United States, and to build a network of researchers who will advance both the practice of laparoscopy and our understanding of chronic pelvic pain.

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As outlined here, the first year emphasizes course work for the Masters in Clinical Investigation (MCI) and initiation of research project(s), and mentored training in the evaluation and treatment of pelvic pain. In the second year, research and clinical efforts are expanded while the final portion of the MCI is completed.

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Research

The following are research projects currently underway or recently completed:

• Laparoscopic supracervical hysterectomy outcomes: the UNC experience in over 300 cases. PI: Lamvu, Steege.
• Laparoscopic treatment of endometriosis: predictors of outcomes. PI: Steege, Zolnoun.
• Laparoscopic vaginal apex revision in the treatment of post-hysterectomy dyspareunia: a series of 52 cases. PI: Steege, Lamvu.
• Characterizing and standardizing vaginal apex pain thresholds in women with and without post-hysterectomy pain. PI: Lamvu, Steege.
• Irritable bowel syndrome and endometriosis: a clinical epidemiologic study of associations, treatment and outcomes after surgery for endometriosis. PI: Steege, R. Williams (Ph.D. in Epidemiology).
• Overnight application of 5% xylocaine for treatment of vulvar vestibulitis. PI: Zolnoun, Steege.
• PTSD in women with chronic pelvic pain: impact on results from treating pelvic pain. PI: Steege
• Measuring sensory thresholds in women with vulvar vestibulitis. PI: Zolnoun
• Experimental drug for treatment of Opioid-Induced Bowel Dysfunction. PI: Lamvu
• Experimental drug for treatment of endometriosis. PI: Steege
• Anxiety and TMD (TemporoMandibular Joint Disorder): Prevalence in women with Vulvar Vestibulitis Syndrome. PI: Zolnoun
• Defining Vaginal Apex Pain Thresholds. PI: Lamvu
• The Utility of Ultrasound in Assisting Initial Laparoscopic Entry. PI: Wechter
  

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