The need for training opportunities in advanced laparoscopic
surgery |
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Authors: | DW Rattner KN Apelgren WS Eubanks |
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Institution: | (1) Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA 02114, USA, US;(2) Department of Surgery, Michigan State University School of Medicine, Lansing, MI, USA, USA;(3) Department of Surgery, Duke University School of Medicine, Durham, NC, USA, USA |
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Abstract: | Background: There is controversy regarding the amount of training necessary to safely perform advanced laparoscopic surgery.
General surgical residency often provides only a low volume of advanced laparoscopic cases and there is growing interest in
nonaccredited fellowships focused on laparoscopic surgery.Objective: To assess surgical residents' perception of the need
for training in advanced laparoscopic surgery in addition to that provided in a standard general surgical residency. Methods:
A 15-item questionnaire was mailed to 985 physicians who either were Society of American Gastrointestinal Endoscopic Surgeons
(SAGES) candidate members or had attended a SAGES resident course in 1998 or 1999. For the purposes of the survey, laparoscopic
Nissen fundoplication, laparoscopic herniorrhaphy, laparoscopic splenectomy, and laparoscopic colectomy were chosen as advanced
procedures. Results: Of the 85 responses obtained, 81% were from respondents who were at the postgraduate fourth-year (PG4)
level or higher. Furthermore, 58% of the respondents had taken a course in advanced laparoscopic surgery outside their residency
program. The respondents believed that to perform the procedures safely and with confidence on entering practice, they needed
to do at least eight each of the selected laparoscopic procedures. As reported, 45% of the respondents had performed three
or fewer laparoscopic hernias; 60% had performed three or fewer laparoscopic Nissen fundoplications; 81% had performed three
or fewer laparoscopic colectomies; and 86% had performed three or fewer splenectomies. Only 32% of the residents expected
to perform more than 10 laparoscopic Nissen fundoplications, only 10% expected to perform more than 10 colectomies, and only
4% expected to perform more than 10 splenectomies before completing their residency. Many respondents (65%) said they would
pursue an additional year of advanced laparoscopic training if it were available. In programs unaffiliated with a fellowship
in advanced laparoscopic surgery, 65% of the residents were concerned that such a fellowship would interfere with residency
training in laparoscopic surgery. In comparison, only 24% of the residents in programs affiliated with a fellowship in advanced
laparoscopic surgery believed that the fellowship interfered with their training, whereas 47% of the residents in programs
affiliated with a fellowship in advanced laparoscopic surgery thought that the fellowship had no impact on their training.
Conclusions: Residents clearly perceive a need for additional training in advanced laparoscopic surgery. Residents from programs
without a laparoscopic fellowship are concerned about a negative impact on their experience from a laparoscopic fellow, but
residents from programs with a laparoscopic fellowship are neutral about the impact of a fellow. |
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