Emergency management station — intraoperative bleeding at the lateral cervical step

Station brief

Format. Emergency management station, approximately 12 minutes. You are the gynaecology registrar in theatre performing a total laparoscopic hysterectomy. A scrub midwife and an anaesthetist are with you; the consultant is in the next theatre and reachable within minutes. The assessor will run the clock and feed you a sequence of intraoperative events.^[1]

Candidate instruction. Lead the management of the patient through a sequence of intraoperative events at the lateral cervical step: brisk bleeding from the tissue crossing over the right ureter, identification of the source vessel, named-vessel haemostasis, confirmation of ureteric integrity, and postoperative care including silent ureteric injury detection. Verbalise your actions, named-vessel control principle, and structured handover to the consultant.^[6]