Surgical Courses in London

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      Establishing a Modern Salivary Gland Practice - Course Description & Daily Objectives 

 

Courses for 2019 to be announced

 

 

The course is designed to support applicants in building a minimally invasive salivary gland service over a period of one year focused around 4 study days with instruction on endoscopic techniques, use of ultrasound, surgical techniques and lithotripsy. The course will be supported by email tutorship and online material throughout the year. Attendance is limited to 12 participants. 

 

COURSE OVERVIEW 

This initiative is designed for practitioners who have a real interest in developing a minimally invasive salivary gland practice of the future. The course extends over a year and is designed in modules to incrementally increase your knowledge and experience. 

 

We are conscious that salivary gland disease is relatively uncommon until you develop your own specialist practice. We are familiar with the situation where one attends a course which is followed by a hiatus before suitable cases present themselves by which time the immediate knowledge provided by the course has dissipated. Consequently this initiative is designed to allow you to build on your knowledge throughout the period of a year. 

 

The instruction is based on 4 study days; the first of which will provide you with sufficient knowledge and experience to commence a salivary gland practice and develop experience. Each subsequent day will build on the previous one. The idea is to have a standard introductory morning session where you can present cases/problems that you have experienced and then to focus on a particular topic commenced by lectures and hands-on experience. Live surgical experience can be provided by agreement. In the period between the study days participants will have access to the mentoring team for advice as required. The course will be both CPD and CME certified. 

 

This course is ideally suited to a unit wishing to introduce a minimally invasive salivary service to its repertoire of services and is open to consultant ENT and oral and maxillofacial surgeons. 

 

COURSE OBJECTIVES

The course aims to slowly build up your experience over the period of a year and also to expose you to new equipment and give you hands-on experience such that you will have a viable clinical practice at the conclusion of the course. It is important that in a relatively rare condition time is taken to develop confidence and experience and to consolidate knowledge. This is difficult to gain from a single day course and this highlights the benefits of a 4 day course spread over the period of a year. This initiative is meant to bridge the gap between education and practical application. The course will be complement by a password protected website which will contain information and lectures. 

 

COURSE DETAIL

Establishing a Modern Salivary Gland Practice

One-year courses for health professionals 

 

Day 1 

Objective

The objective of day 1 is to provide the participants with the skills to safely identify and select appropriate and “easy” cases for treatment in order to commence a rudimentary salivary gland service. One should expect this to include a diagnostic service incorporating both ultrasound and endoscopy complementing therapeutic treatments such as basket retrieval of small stones and dilatation of strictures. 

 

AM Day 1

1. Review of minimally invasive modalities (stones, strictures, benign tumours)

• Compendium of literature review for stones, strictures and benign tumours. 

• Literature from commercial sponsors relating to minimally invasive therapy, instruments and ultrasound machines. 

• Videos and teaching aids to support the applicants on the course and in building lectures and demonstrations for their referring practitioners. 

2. Classification of salivary gland disease suitable for minimally invasive therapy (stones, strictures, inflammatory conditions, benign tumours – extracapsular dissection)

• Detailed evaluation of salivary stones - size, position, clinical features, complications.

• Strictures - description of symptoms, classification and management at different stages of development, modern approaches to management.

• Inflammatory conditions – a range of conditions that have no obvious organic cause will be discussed including sialosis, chronic sialadenitis, and mega ducts.

• Benign tumours – minimally invasive management of benign tumours will be described with modern treatment and outcome. 

3. Design of a salivary gland service (manpower, equipment, organisation)

• Radiation based salivary gland service.

• Traditional service based on diagnostic radiology and treatment.

• Modern salivary service based on ultrasound and endoscopy. 

• Optimum manpower and training. 

• Equipment required to commence the service. 

• Development of a referral base. 

• The problem case.

4. Preparing a business case for a minimally invasive service

• A model hospital business application form will be provided that complies with administrative requirements for hospital recognition.

• Model application form for introducing a new service to hospital. 

• Business case for using minimally service to reduce general costs with rationale for moving to new equipment supported by Cook Medical to support the argument for the purchase of introducers, baskets, dilators, etc. 

PM Day 1

1. Introduction to essential equipment to commence a salivary gland service after the course

• Ultrasound. 

• Brochures for each machine.

• Instruction on how to use each machine - instruction on anatomy and images that can be obtained.

2. Endoscopes 

• Two types of endoscopes will be described and advantages discussed.

• Instruction on how to deploy the endoscopes, equipment required, support staff.

• List of instruments and photographs of instrument sets to be provided.

3. Lithotripsy

• New modern lithotripsy techniques that avoid expensive lithotripters will be described and brochures provided. 

Participants should be able to commence simple endoscopy and ultrasound examination at the end of day one of the course. This will enable them to start recruiting patients and commence simple treatment. 

 

In order to facilitate the development of a minimally invasive salivary gland service, manufacturers have been encouraged to bundle their equipment together so that they can be introduced to various units at minimal cost. This will facilitate the introduction of this equipment into hospitals in conjunction with the commercial sponsors. 

 

Day 2  

Objectives

It is hoped that the delegates on the second study day have already commenced the provision of a rudimentary salivary gland practice in their own units. They may have completed only a handful of cases but this would be sufficient to gain experience and raise pertinent questions regarding treatment and management. 

 

The objective on this day is to answer queries and problems encountered by the participants in the previous three months, and together with the sponsors try to provide solutions. 

 

This study day will introduce a new dimension which is surgically-assisted endoscopic therapy. Less than 50% of salivary stones can be treated by endoscope and basket. Many require surgical intervention but using a surgical technique that preserves both the submandibular and parotid glands. This is the focus of the second day. 

 

AM Day 2

1. Feedback by delegates on establishing a minimally invasive service

• This subject area will be repeated on each study day. It is anticipated that as the delegates gain more experience, the feedback and problem sessions will become more informative. 

• Feedback on introducing a minimally invasive service to the hospital regarding costs, access to equipment, etc.

• Clinical problems encountered in managing patients, diagnosis and treatment. 

2. Update on equipment with hands-on session

• Delegates who have not had access to equipment or elements of the equipment required can bring their knowledge up to date by using ultrasound, endoscope, and lithotripters in a non-clinical setting. The session is designed for the delegates to refresh their experience and the equipment.

PM Day2 

1. Videos and lectures 

• Minimally invasive surgery for submandibular stones.

• Minimally invasive surgery for parotid stones.

• Dilatation of strictures.

• Managing complications. 

• Extracapsular dissection. 

2. Ultrasound instruction: Group lecture followed by small group teaching and live demonstrations

• Introduction to ultrasound machines.

• Explanation of anatomy, managing the picture. 

• Salivary gland pathology.

• Ultrasound-guided endoscopic cannulation of ducts.

• Ultrasound-guided stone retrieval by basket.

Day 3  

Objectives

It is intended that by day 3 of the course most delegates would have been practising some form of minimally invasive salivary therapy in their own units. The object of this study day is to consolidate experience, share knowledge and start to build on basic skills to provide a more encompassing and complex service. The surgical aspects will be revisited as it is anticipated that participants will progress carefully through this phase of instruction. 

 

AM Day 3 

1. Feedback by delegates on their progress in commencing a minimally invasive salivary service

• Discussion on successes. 

• Discussion on how to propagate news of a new service. 

• Presentation of cases.

Delegates to present cases treated, highlighting particularly difficult cases and failures. 

• Cases for discussion. 

• Review of equipment. 

PM Day 3 

• Video-based lectures on surgical management of salivary gland disease will be repeated in order to refine techniques and answer queries of delegates who have commenced surgical intervention.

• Minimally invasive surgery for submandibular stones.

• Minimally invasive surgery for parotid stones. 

• Dilatation of strictures. 

• Extracapsular dissection. 

1. A new facility will be offered regarding live surgery. Lectures and videos are invaluable and may be all that is required for our colleagues to grasp and develop new surgical techniques. But taking part in live surgery is the ultimate in providing instruction. If a delegate has identified a suitable patient, and wishes to be supervised in a case then this can be facilitated. Operating can be arranged at King Edward VII which is a private facility in Central London. Here, the faculty are able to provide this service and instruct and willing to do so without fee from the patient. However, the hospital will levy a fee for their costs. It may be possible for more than one delegate to support a patient and be involved in the case and commercial sponsors may also help with this. Live surgical instruction is only available if suitable patients are identified.

 

2. Endoscopes

• Practical aspects of endoscopy, their use with baskets, forceps and brush biopsies.

Day 4 

Objectives

By the final study day, it is hoped that all delegates would have the appropriate equipment within their units, are in negotiations with their sponsors and will be providing a minimally invasive salivary service to their community. This study day is designed to consolidate experience, provide advice on refinements and how to adapt a minimally invasive practice for their specific community. 

 

AM Day 4

1. Feedback by delegates on progress with minimally invasive salivary service 

• Presentation of cases by delegates for discussion.

• Review of equipment and hands on demonstration directed by delegates’ experience (ultrasound, endoscope, hand held lithotripter).
• Managing problems encountered for review and discussion of model for salivary gland service. 

• Review of business case – what are the problems being faced.

• Review of equipment.

• Elective training required with ultrasound, endoscopes, lithotripsy, extracapsular dissection.

• Tutorials provided for minimally invasive surgery.

PM Day 4

• Live surgery by video link. 

• Review of advanced techniques. 

• Management of ranula. 

• Management of mega ducts. 

• Role of nerve monitors. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

 

Prof Mark McGurk MD BDS FRCS FDSRCS DLO, King Edward VII Hospital, Beaumont Street, London W1G 6PF  Email: mark.mcgurk@salivary-gland.co.uk Secretary: +44 (0)20 7403 3876  Fax +44 (0)20 7357 6824