questionnaire enclosed - Service d'Urologie CHU Henri Mondor

POST FELLOWSHIP CLINICAL EXPERIENCE QUESTIONNAIRE
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First Name
Gender
male
female
Family Name
Age
Country
How many years are you in the field of urology including residency
When did you arrive in Créteil (mm/yyyy)
time spent
months
When did you leave Créteil (mm/yyyy)
What is your position now
Senior surgeon in public hospital
Senior surgeon in private hospital
Combination of private and hospital practice
Still in training position (resident or Chief resident)
How many days do you generaly operate every week
1 2 3 4 5 6
How many laparoscopic procedures do generaly you perform every
week
I do not perform laparoscopy
Not every week
1-2 cases a week
2-4 cases a week
More than 4 cases a week
How much in your practice is laparoscopic
procedures
%
How many cases in the following operations had you performed has FIRST SURGEON
cholecystectomy
appendicectomy
colon surgery
varicocele
adrenalectomy
nephrectomy
nephro ureterectomy
pyeloplasty
kidney biopsy
radical prostatectomy
other
BEFORE COMING TO CRETEIL
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
AFTER COMING TO CRETEIL
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
0 1-5 6-20 >20
During your stay in Créteil, what is your opinion concerning the training you received personnaly in laparoscopy
very good good fair poor very poor
Which approach do you perform minly
trans peritoneal
retro peritoneal

POST FELLOWSHIP CLINICAL EXPERIENCE QUESTIONNAIRE
Did you performed changes in the surgical techniques that you learned in Créteil after coming back
yes
no
If yes, did you performed changes in the following points:
number of trocars
distribution of trocars
approach (trans vs. retro peritoneal)
retrieval of the specimen
management of distal ureter in nephro ureterectomy
other
yes
yes
yes
yes
yes
yes
no
no
no
no
no
no
What complications did you encounter in your procedures and how many cases did you have
major hemorrhage
conversion
bowel
infection
port site tumor
port site hernia
rectal injury
other complication
yes
yes
yes
yes
yes
yes
yes
yes
no
no
no
no
no
no
no
no
At this stage of practice, would you like to receive more training in laparoscopy
Please explain why
yes
no
If you have any comments, please write them here:
Thank you for your participation
If you can not send this form by email, please print it and send it by regular mail to:
Dr Stéphane Larré
Hopital H. MONDOR
Service d'Urologie - Pr Abbou
51 av de Lattre de Tassigny
94010 CRETEIL - FRANCE