Epworth HealthCare Gynaecology – Scope of Clinical Practice Gynaecology – Scope of Clinical Practice Clinical Institute: Women’s and Children’s Procedure Name Tier Adnexal surgery, including ovarian cystectomy, oophorectomy, salpingectomy, and Tier A conservative procedures for treatment of ectopic pregnancy Aspiration of breast masses Tier A Bladder biopsy and diathermy Tier A Cervical biopsy Tier A Colpocleisis Tier A Colpoplasty Tier A Colposcopy Tier A Consulting Tier A Cystoscopic injection of Botulinum Toxin Tier A Cystoscopy as part of gynaecological procedure Tier A D&C for abortion Tier A Delayed anal sphincter repair Tier A Diagnostic laparoscopy Tier A Endometrial ablation Tier A Exploratory laparotomy, for diagnosis and treatment of pelvic pain, pelvic mass, Tier A hemoperitoneum, endometriosis and adhesions Gynaecological sonography Tier A Hysterectomy, abdominal, vaginal, excluding laparoscopic Tier A Hysterosalpingography Tier A Hysteroscopic surgery Tier A Hysteroscopy Tier A I&D of bartholin cyst or perineal abscess Tier A I&D of pelvic abscess Tier A Incidental appendectomy Tier A Insertion and removal of IUCD Tier A Intrauterine myomectomy with power morcellation by hysteroscopic approach Tier A Laparoscopic surgery (excludes laparoscopic myomectomy with power morcellation) Tier A Laparotomy Tier A Marsupialisation of bartholin cysts Tier A Minor gynaecological surgical procedures (endometrial biopsy, dilation and curettage, Tier A treatment of Bartholin cyst and abscess) Myomectomy Tier A Operation for treatment of urinary stress incontinence: vaginal approach, retropubic urethral Tier A suspension & sling procedure Operations for treatment of benign pelvic disease: D&C with conization, laparotomy, Tier A abdominal hysterectomy, vaginal hysterectomy, salpingectomy, oophorectomy Operative laparoscopy for pelvic pain and infertility Tier A Repair of rectocele, enterocele, cystocele, or pelvic prolapse Tier A Repair urethral diverticulum Tier A Sacral Colpopexy – open or laparoscopic Tier A TAH/Vaginal hysterectomy Tier A Trans cervical endometrial resection Tier A Page 1 of 3 Treatment of residual ovaries by laparoscopy Tier A Tubal sterilisation Tier A Tuboplasty and other infertility surgery (not microsurgical) Tier A Ureteric Stenting Tier A Urethroscopy ad female urodynamic evaluation Tier A Uterosacral vaginal vault fixation Tier A Vaginal repair/sacrospinous/Colpopexy surgery Tier A Vulvar biopsy Tier A Vulvectomy Tier A Bladder/ureteric surgery during advanced cancer resection, as encountered during cancer Tier B resection Bowel resection – large and small as required during ovarian cancer surgery Tier B Colposcopically directed lower genital tract (LGT) laser surgery Tier B Excision of AFS score 3 endometriosis (Level 4) Tier B Excision of AFS score 4 endometriosis (Level 6) Tier B Implantable neuromodulation devices (sacral and bladder) Tier B Injectibles for stress incontinence Tier B IVF procedures Tier B Laparoscopic Burch colposuspension (Level 5) Tier B Laparoscopic laser surgery Tier B Laparoscopic myomectomy (Level 5) Tier B Laparoscopic myomectomy with power morcellation (Level 5‐6) Tier B Laparoscopic oncologic procedures (Level 6) Tier B Laparoscopic pelvic floor repair (Level 6) Tier B Laparoscopic pelvic floor repair incl hysteropexy Tier B Laparoscopic removal of residual ovary especially with anatomic distortion (Level 6) Tier B Laparoscopically assisted vaginal hysterectomy (Level 4) Tier B Microsurgery: fallopian tubes/vasectomy reversals Tier B Myocutaneous flaps, skin grafting Tier B Paediatric practice ‐ Any clinical practice involving the treatment of a patient under the age of Tier B 18 years Para‐aortic and pelvic lymph node dissection Tier B Pelvic exenteration Tier B Radical surgery for treatment of gynaecological malignancy to include procedures on bowel, Tier B ureter, bladder as indicated Robotic assisted hysterectomy +/‐ BSO Tier B Robotic assisted hysterectomy +/‐ BSO with uterine myomectomy with power morcellation Tier B Robotic myomectomy with power morcellation Tier B Robotic radical hysterectomy & BSO +/‐ pelvic lymph node dissection +/‐ para‐aortic lymph Tier B node dissection Robotic resection of endometriosis Tier B Robotic sacro colpopexy Tier B Robotic‐assisted mesh sacrocolpopexy Tier B Robotic‐assisted Myomectomy Tier B Surgery for gynaecological malignancy Tier B Total laparoscopic hysterectomy (Level 5) Tier B Treatment of invasive carcinoma of the vagina by radical vaginectomy and other related Tier B surgery Treatment of invasive carcinoma of vulva by radical vulvectomy with groin dissection Tier B Treatment of malignant disease with chemotherapy to include gestational trophoblastic Tier B disease Uretorovaginal fistula Tier B Page 2 of 3 Uterine / vaginal isotope implants Tier B Vaginal mesh repair including Prolift, Apogee, Perigee etc Tier B Vesicovaginal fistula, rectovaginal fistula repair Tier B Page 3 of 3 .