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MIGS Diploma

Level 2

Surgical Competence

The GESEA MIGS Diploma is a video-based expert-reviewed diploma where surgical skills are evaluated by performing a select number of laparoscopic and hysteroscopic procedures.

To receive your MIGS Diploma, you first must acquire the necessary surgical competence both in laparoscopy and in hysteroscopy.

You must provide your documented testimony of surgical clinical practice curriculum over a maximum period of 5 years together with supporting documentation to diploma@esge.org

Steps To Acquire Your MIGS Diploma

1

The next step is to submit the schedule of your first procedure stating the date when you will perform the actual procedure, you cannot use existing recorded video material. There are five different procedures to schedule with a total cost of 500 euro. As soon as you have scheduled your first procedure, you have entered the MIGS Diploma programme.

2

After you have performed a procedure, you have 48 hours to submit the video of the procedure through the GESEA Diploma Video submission system and the report of the anaesthesiologist to diploma@esge.org. For each procedure, you have to make a separate submission.

3

When the ESGE has received all your recorded procedures, they will be expert-reviewed and rated.

Prerequisites for MIGS Diploma

MIGS Certificate

You have acquired the MIGS Certificate.

Laparoscopic Hysterectomy

The surgeon is expected to perform a total laparoscopic hysterectomy of own choosing.
The procedure will be evaluated by 2 international expert reviewers on 4 steps of the hysterectomy: Dissection of the broad ligament and the IP ligament, Bladder Dissection, Colpotomy, Laparoscopic vaginal suture.
For these 4 steps, a specific evaluation scale is used by the reviewers: the H-OSATS scale (Knight S et Al. PLoS One. 2018. 2;13(1): e0190580.)
For recommendations on the technical aspects of a laparoscopic hysterectomy, please consult with attention the article Surgical steps of total laparoscopic hysterectomy as published in Facts, Views and Vision in ObGyn, the journal of the ESGE.
Video examples for these 4 steps are also available in this section.

1.1 Broad Ligament
1.2 IP Ligament 
2 Bladder Dissection 
3 Colpotomy 
4 Laparoscopic Vaginal Suture 

Hysteroscopy

Execute 2 diagnostic and 2 operative hysteroscopies as a first surgeon.
One diagnostic hysteroscopy of any case, selected by the applicant and one case of a menopausal or nulliparous patient. One case of polypectomy (with a polyp at least 1.5cm) and one case of myomectomy.

Please pay attention to:

- Vaginoscopic, atraumatic cervical os-canal entry
- Hysteroscope navigation ability, avoiding forceful progression of the hysteroscope and use of rotational movements following the cervical canal and reaching the endometrial cavity
- Systematic examination of the cervical canal and endometrial cavity
- Panoramic and well as close-up views
- Effort to evaluate the endometrium status
- Ruling out or accurate diagnosis of congenital uterine anomalies
- Concomitant use of peri and intra-operative sonography where needed
- Diagnosis of the pathology based on hysteroscopic criteria eg type of endometrium, type of myoma, etc
- Description of pathology, anatomical location, degree of severity
- Diagnosis and differential diagnosis where relevant
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