GESEA Certification - Robotics | SERGS - European Society for Gynaecological Endoscopy

Last Name*

First Name*

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Congress Registration Reference Number*

Please enter your Congress Registration Reference Number. All NON-registered participants, please fill in the following CODE: 111 111

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Email*

Date of Birth*

Gender

Male
Female

Dominant hand side

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Affiliation/Institute*

ACADEMIC INFORMATION

Current Academic Level*

Student
Resident
Specialist in Ob&Gyn
Specialist in other discipline
Other

When you chose "Specialist in other discipline/Other" please specify:

EXPOSURE TO ATYPIC PSYCHOMOTOR SKILLS

Video games

How many hours per week?*

EXPOSURE TO ATYPIC PSYCHOMOTOR SKILLS

Musical instrument

How many hours per week?*

EXPERIENCE IN ROBOTICS IN THE OR

ESGE Classification below is used for descriptions of levels. Please fill in all levels.

No experience in Robotics

Indicate the experience in third (advance) level procedures.*

These include: ● Hysterectomy ● Myomectomy ● Urinary Incontinence ● Extensive Adhesiolysis ● Severe Endometriosis ● Bowel or bladder lesions reparation

0
<30
30-50
>50

Indicate the experience in fourth level procedures.*

These include: ● Pelvic floor disorders ● Oncology (Lymphadenectomy, radical hysterectomy, axiloscopy) ● Recto-‐vaginal endometriosis

0
<30
30-50
>50

Exposure to hands-‐on lab Robotics training.*

These include: Robotics Simulator

No exposure
1 - 2 sessions
regular exposure (more than 2 sessions a year)

GESEA Certification Robotics

Specify for which session you wish to enroll during

Certification*

Preferred Date*

Please indicate your preferred date for your session 4th or 5th June 2025. Please note that as places are limited, your preferred date may not be available and you will be allocated a place in the next available session.

Total

0,00 €

Payment type*

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Credit Card

Card Details

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ESGE Academy
IBAN: BE63 3630 8342 6508
BIC: BBRUBEBB
Bank address: ING Leuvensesteenweg 203, 3390 Sint-Joris-Winge, Belgium
Reference: Your name and session title

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I have read and agree with the terms of use and the privacy policy of the European Society for Gynaecological Endoscopy

Date

Untitled

GESEA Certification - ROBOTICS

ACADEMIC INFORMATION

EXPOSURE TO ATYPIC PSYCHOMOTOR SKILLS

GESEA Certification Robotics

Principal Sponsors of the ESGE

Major Sponsor of the ESGE