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Dyke C, Patel N, John AS, Kligman MD, Kavic SM. Why do not we talk about MIS fellowship? A short review of the short literature. Surg Endosc 2023:10.1007/s00464-023-10023-y. [PMID: 37081243 DOI: 10.1007/s00464-023-10023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/12/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The minimally invasive surgery (MIS) fellowship has existed for three decades and has steadily grown in both number of positions available and variety of techniques practiced. Despite continued popularity, growth, and wide breadth of surgical techniques of the MIS fellowship, publication rates in medical journals regarding these fellowships have not been as robust as one may expect. Our goal was to review the available literature on MIS fellowship. METHODS We reviewed PubMed to search for articles pertinent for MIS fellowship. The initial search included "MIS fellowship" "minimally invasive surgery fellowship" and "laparoscopy fellowship." Articles pertaining to MIS fellowship were then reviewed by title and abstract for content. Articles were excluded from subsequent analysis if they focused on disciplines that were not direct extensions of general surgery (such as urology, gynecology, oncology). Using similar search techniques, we tabulated unfiltered publications rates specific to other major surgical fellowship disciplines. The metric articles per position was created by dividing the total number articles for each discipline by the annual fellowship positions RESULTS: An initial review of available literature produced 134 articles pertinent to MIS fellowship. Further analysis for direct relevance to MIS yielded only 58 published articles. MIS had the fewest number of publications and smallest APP, 0.7, of any of the major fellowship disciplines. CONCLUSIONS There is a surprising dearth of material on MIS fellowship. While, MIS fellowship is a one-year experience, we have the opportunity to build on three decades of clinical experience to continue optimize the fellow experience and improve subspecialized surgical training and patient outcomes. This could be facilitated through broadened focus of inquiry and publication of findings.
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Affiliation(s)
- Christopher Dyke
- University of Maryland Medical Center, 29 South Greene Street, Baltimore, MD, GS 631, USA.
| | - Neerav Patel
- University of Maryland Medical Center, 29 South Greene Street, Baltimore, MD, GS 631, USA
| | - Ace St John
- University of Maryland Medical Center, 29 South Greene Street, Baltimore, MD, GS 631, USA
| | - Mark D Kligman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, MD, USA
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Nebbia M, Kotze PG, Spinelli A. Training on Minimally Invasive Colorectal Surgery during Surgical Residency: Integrating Surgical Education and Advanced Techniques. Clin Colon Rectal Surg 2021; 34:194-200. [PMID: 33815002 DOI: 10.1055/s-0041-1722843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgery is an ever-evolving discipline and continually incorporates new technologies that have improved the ability of the operating room surgeon to perform. The next generation of minimally invasive surgery includes laparoscopic and robotic-assisted procedures. Graduating residents may be expected to have the skills to perform common colorectal procedures using these technologies, and residency programs are developing curriculums to teach these skills. Minimally invasive techniques are challenging and learning only by observation and practice alone is difficult. This requires dedicated training and mentoring. New simulation methods have been conceived specifically for minimally invasive procedures, and these embrace a combination of virtual reality simulators and box trainers, with animal and human tissue, as well as synthetic materials. The aim of this review is to provide an overview of training in minimally invasive colorectal surgery with a focus on different types of simulators that build the basis to develop and include a multistep training approach in a structured training curriculum for minimally invasive colorectal procedures.
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Affiliation(s)
- Martina Nebbia
- Department of Surgery, Colon and Rectal Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Health Sciences Postgraduate Program, Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
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Balaa F, Moloo H, Poulin E, Haggar F, Trottier D, Boushey R, Mamazza J. Broad-Based Fellowships: A Cornerstone of Minimally Invasive Surgery Education and Dissemination. Surg Innov 2016; 14:205-10. [DOI: 10.1177/1553350607305374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aware of the trends in surgery and of public demand, many residents completing a 5-year training program seek fellowships in minimally invasive surgery (MIS) because of inadequate exposure to advanced MIS during their residency. A survey was designed to evaluate the effectiveness of a broad-based fellowship in advanced laparoscopic surgery offered in an academic health science center. The questionnaire was mailed to all graduates. Data on demographics, comfort level with specific laparoscopic procedures, and opinions regarding the best methods of acquiring these skills were collected. Most of the surgeons entered the fellowship directly after residency. The majority of these surgeons are academic surgeons. Fellows performed a median of 187 cases by the end of their training and felt comfortable operating on foregut, hindgut, and end organ. A full year of training was found to be the best format for appropriate skill transfer. A broad-based MIS fellowship meets the needs of both academic and community surgeons desiring to perform advanced laparoscopic procedures.
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Affiliation(s)
- F. Balaa
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - H. Moloo
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - E.C. Poulin
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - F. Haggar
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - D.C. Trottier
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - R.P. Boushey
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - J. Mamazza
- Minimally Invasive Surgery Group, The Ottawa Hospital, University of Ottawa, Ontario, Canada,
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Hallet J, Mailloux O, Chhiv M, Grégoire RC, Gagné JP. The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period. Can J Surg 2015; 58:92-9. [PMID: 25598180 DOI: 10.1503/cjs.019713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although minimally invasive surgery (MIS) has been quickly embraced, the introduction of advanced procedures appears more complex. We assessed the evolution of MIS in the province of Quebec over a 5-year period to identify areas for improvement in the modern surgical era. METHODS We developed, test-piloted and conducted a self-administered questionnaire among Quebec general surgeons in 2007 and 2012 to examine stated MIS practice, MIS training and barriers and facilitators to the use of MIS. RESULTS Response rates were 51.3% (251 of 489) in 2007 and 31.3% (153 of 491) in 2012. A significant increase was observed for performance of most advanced MIS procedures, especially for colectomy for benign (66.0% v. 84.3%, p < 0,001) and malignant diseases (43.3% v. 77.8%, p < 0,001) and for rectal surgery for malignancy (21.0% v. 54.6%, p < 0.001). More surgeons practised 3 or more advanced MIS procedures in 2012 than in 2007 (82.3% v. 64.3%, p < 0,001). At multivariate analysis, the 2007 survey administration was associated with fewer surgeons practising advanced MIS (odds ratio 0.13, 95% confidence interval 0.06-0.29). In 2012, more respondents stated they gained their skills during residency (p = 0.028). CONCLUSION From 2007 to 2012 there was a significant increase in advanced MIS procedures practised by general surgeons in Québec. This technique appears well established in current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development. Results from this study could be used as a baseline for studies focusing on ways to further improve the MIS practice.
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Affiliation(s)
- Julie Hallet
- The Division of General Surgery, Sunybrook Health Sciences Centre - Odette Cancer Centre, and the Department of Surgery, University of Toronto, Toronto, Ont
| | | | - Mony Chhiv
- The Department of Surgery, Université Laval, and the Department of Surgery, CHU de Québec - Hôpital Saint-François d'Assise, Québec Centre for Minimally Invasive Surgery (QCMIS), Québec, Qué
| | - Roger C Grégoire
- The Department of Surgery, Université Laval, and the Department of Surgery, CHU de Québec - Hôpital Saint-François d'Assise, Québec Centre for Minimally Invasive Surgery (QCMIS), Québec, Qué
| | - Jean-Pierre Gagné
- The Department of Surgery, Université Laval, and the Department of Surgery, CHU de Québec - Hôpital Saint-François d'Assise, Québec Centre for Minimally Invasive Surgery (QCMIS), Québec, Qué
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Rees M, Saklani A, Shah P, Haray P. A structured preceptorship programme for laparoscopic colorectal surgery in Wales: An early experience. J Minim Access Surg 2014; 10:185-9. [PMID: 25336818 PMCID: PMC4204261 DOI: 10.4103/0972-9941.141512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/29/2013] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A single experienced laparoscopic colorectal surgeon introduced an outreach preceptorship programme (OPP) for laparoscopic colorectal surgery (LCS) in Wales with the aim of supporting consultants in the early stages of their learning curve, as well as to help avoid some of the problems faced by self-taught laparoscopic surgeons. The structured programme consisted of a minimum 1 day master class at the preceptor's operating theatre, followed by multiple outreach visits by the preceptor. The aim of this study was to evaluate the effectiveness and early experience of this programme. MATERIALS AND METHODS Clinical end-points (conversions, morbidity/mortality and length of hospital stay) were analysed from a prospectively maintained database. Evaluation of the programme was based on interviews with the preceptee surgeons performed by a neutral observer. RESULTS Between May 2008 and July 2010, 11 Consultants (six hospitals) were preceptored (two still in programme). 66 cases (20 in the master class, 46 as an outreach service) were performed as a part of this programme. CLINICAL OUTCOME Conversion rate and 30-day mortality was 1.5%. Morbidity was reported at 12% (8/66) and median length of stay was 6 days. Programme evaluation: All interviewed respondents found the master class and outreach service to be well-organised and would recommend it to their colleagues. The median number of outreach visits per hospital was 5. All the preceptees have performed independent cases since the programme. CONCLUSION This OPP delivers one-to-one coaching at the point of service delivery and has been shown to be effective in achieving safe transference of skills to those wishing to develop a service for LCS.
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Affiliation(s)
- Michael Rees
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, Wales, UK
| | - Avanish Saklani
- Department of Surgery, Princess of Wales Hospital, Bridgend, UK
| | - Parin Shah
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, Wales, UK
| | - Puthucode Haray
- Department of Surgery, Prince Charles Hospital, Merthyr Tydfil, Wales, UK ; Department of Coloproctology, University of Glamorgan, Pontypridd, UK
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Asano TK, Soto C, Poulin EC, Mamazza J, Boushey RP. Assessing the impact of a 2-day laparoscopic intestinal workshop. Can J Surg 2011; 54:223-6. [PMID: 21651832 DOI: 10.1503/cjs.005310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Surgical educators have responded to the demand for increased skills in minimally invasive surgery by offering short technique-focused workshops at academic centres. The purpose of this study was to determine the impact of a comprehensive laparoscopic intestinal workshop for the adoption of laparoscopic colonic surgery. METHODS A 2-day comprehensive laparoscopic intestinal surgery workshop included didactic teaching and supervised hands-on practice of numerous laparoscopic colon resections on a cadaveric model. Participants completed pre-, post- and 6-month postcourse questionnaires. RESULTS The participants (n = 39) had been in practice for a mean of 10 (interquartile range 3-18) years. Fifty-one percent (n = 20) were already performing laparoscopic colectomies as part of their practices prior to the course. Regardless of whether they were performing laparoscopic colectomies prior to the course or not, attending the 2-day workshop improved their self-assessed preparedness to perform laparoscopic colectomies. Six months after the intestinal workshop, 10 of 16 respondents who were not performing laparoscopic colectomies prior to the course had performed at least 1 since the course. Seven of these individuals had a preceptor for their first case. Reasons cited for not performing a laparoscopic colectomy since the workshop included perceived inadequate surgical skill set, a lack of preceptor and the lack of an appropriate patient. CONCLUSION A comprehensive laparoscopic intestinal workshop contributed to the perceived acquisition of advanced laparoscopic surgical skills. Local laparoscopic preceptorship was an important adjunct to the workshop for the incorporation of laparoscopic colorectal surgery into practice.
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Affiliation(s)
- Tracey K Asano
- The Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
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Akmal Y, Bailey C, Baek JH, Metchikian M, Pigazzi A. Oncological outcomes of laparoscopic colon resection for cancer after implementation of a full-time preceptorship. Surg Endosc 2011; 25:2967-71. [PMID: 21487881 DOI: 10.1007/s00464-011-1654-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/20/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND The learning curve for laparoscopic colectomy (LC) is considered long and difficult. The presence of a preceptor may shorten the learning curve of LC and ensure adequate oncologic and short-term results. City of Hope implemented a full-time LC preceptorship between September 2004 and March 2006 with one experienced surgeon assisting other surgeons. We review our outcomes with laparoscopic colon resection for colon adenocarcinoma after implementation of this preceptorship. METHODS All cases of laparoscopic colon resection for adenocarcinoma performed from September 2004 to April 2009 were retrospectively reviewed. We compared the patients in two groups: group 1 had surgery performed during the preceptorship period from September 2004 to March 2006 (n = 39) and group 2 had procedures done between April 2006 and April 2009 (n = 74). Clinical characteristics evaluated included sex, age, body mass index (BMI), ASA level, and history of previous abdominal surgery. Postoperative variables evaluated included type of operation, conversion to open surgery, estimated blood loss (EBL), operation time, stage, number of harvested lymph nodes, time to liquid diet, postoperative stay, complications, and 30-day mortality rate. Kaplan-Meier survival curves were constructed based on disease-free survival (DFS) and overall survival (OS). RESULTS One hundred thirteen patients underwent LC for adenocarcinoma during the study period. Mean age and BMI were similar between the groups. There was also no significant difference in conversion rates (10.3% vs. 13.5%, p = 0.77) or total complications (25.6% vs. 41.9%, p = 0.088) between groups 1 and 2, respectively. There was a significantly greater number of lymph nodes removed in the post-preceptor period (20.3 vs. 15.8, p = 0.007). The 3-year DFS rate was 96.5%, with a mean follow-up of 22.8 months, and the 3-year OS rate was 88.9%, with mean follow-up of 22.1 months, for the entire cohort. CONCLUSION Implementation of a program with a full-time preceptorship can help institutions overcome the challenges of laparoscopic colectomy and achieve acceptable postoperative and oncologic outcomes.
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Affiliation(s)
- Yasir Akmal
- Department of General and Oncologic Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
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Bradnock T, Hammond P, Haddock G, Sabharwal A. A Roadmap for the Establishment of Pediatric Laparoscopic Fundoplication. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S41-5. [DOI: 10.1089/lap.2008.0130.supp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy Bradnock
- Department of Pediatric Surgery, The Royal Hospital for Sick Children, Glasgow, Scotland
| | - Phillip Hammond
- Department of Pediatric Surgery, The Royal Hospital for Sick Children, Glasgow, Scotland
| | - Graham Haddock
- Department of Pediatric Surgery, The Royal Hospital for Sick Children, Glasgow, Scotland
| | - Atul Sabharwal
- Department of Pediatric Surgery, The Royal Hospital for Sick Children, Glasgow, Scotland
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Singh SS, Marcoux V, Cheung V, Martin D, Ternamian AM. Core Competencies for Gynecologic Endoscopy in Residency Training: A National Consensus Project. J Minim Invasive Gynecol 2009; 16:1-7. [DOI: 10.1016/j.jmig.2008.09.620] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Revised: 09/25/2008] [Accepted: 09/26/2008] [Indexed: 11/25/2022]
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Rogers DA. The Role of Simulation in Surgical Continuing Medical Education. SEMINARS IN COLON AND RECTAL SURGERY 2008. [DOI: 10.1053/j.scrs.2008.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Martel G, Poulin ÉC, Mamazza J, Boushey RP. Laparoscopy influences hiring practices within academic surgical departments. Surg Endosc 2008; 23:341-6. [DOI: 10.1007/s00464-008-9934-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 02/01/2008] [Accepted: 04/05/2008] [Indexed: 11/28/2022]
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Gagné JP, Billard M, Gagnon R, Laurion M, Jacques A. Province-wide population survey of acute appendicitis in Canada. New twists to an old disease. Surg Endosc 2007; 21:1383-7. [PMID: 17653814 DOI: 10.1007/s00464-007-9227-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 09/19/2006] [Accepted: 10/09/2006] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study, sponsored and conducted by Le Collège des Médecins du Québec, audited the management of acute appendicitis in the Province of Québec (Population 7.6 million), Canada, over a period of 1 year (April 2002-March 2003). METHODS A questionnaire was sent to the Health Records Department of all hospitals surgically treating appendicitis in the province. Data from 85 (100%) hospitals were received and reviewed. RESULTS During the study period, 7,599 appendectomies were performed, and 5,707 (75%) were selected for study (55% men). The rate of normal and perforated appendix was 5.4% and 15.9% respectively. Median hospital stay for simple and perforated appendicitis was 2.6 and 5.8 days, respectively. At least one imaging procedure was done in 86% of cases (23% computed tomography [CT], 55% ultrasound). Antibiotics were not given in 7% of cases and in 8% of patients with a perforation. Seventeen percent of patients did not receive preoperative or intraoperative doses, and postoperatively, 69% of patients received unnecessary doses. Laparoscopy was used in 35% of cases and was associated with a reduction in postoperative stay for simple (2.6 versus 2.9 days, p < 0.001) and perforated appendicitis (4.6 versus 5.9 days, p = 0.004). A low rate of laparoscopy (<25%) was found in 53% of teaching (University and Affiliated) and 45% of nonteaching institutions. Conversion to open surgery was necessary in 9.7% of simple appendicitis and 29.3% of perforated ones (p < 0.001). CONCLUSIONS Although results of this survey are comparable to those of similar published series, a few concerns emerge. Many have to do with patient noncompliance with recommended antibiotic usage for acute appendicitis. Further, although laparoscopy seems to be slowly making its way into the surgical armamentarium, the low rate of laparoscopic appendectomies in teaching hospitals raises the issue of appropriate resident training.
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Affiliation(s)
- J-P Gagné
- Centre Hospitalier, Universitaire de Québec, Québec, PQ, Canada, G1L 3L5.
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