Evaluation Of Adequate Training in Advanced Laparoscopic Surgery

Laparoscopic Trainer

Training In Laparoscopic Surgical Techniques

In the present study, a systematic review of the literature published in the last 5 years in relation to the subject carries out. Using the electronic databases. With the search term Training of the surgeon in laparoscopic surgical techniques and analyzing the references. Laparoscopic Trainer.

Laparoscopic Training mockup with Laparoscopic Trainer is a useful choice.

New Era of Laparoscopic Surgery

The title and abstracts of publications indexed between January 2000 and March 2006. Conferences and unpublished papers exclude from the present review. Determine which are the factors that have influenced this new era of laparoscopic surgery. Evaluate the way in which training carries out and assess the results.

Data Analysis Results

Search the databases (2000-present) and record the Cochrane controlled trial using general laparoscopic surgery training, certificates, and clinical licenses. Considered only published articles. Get the full text of all possible communication studies. The reference list for these studies then looks for additional repositories. Systematically review available evidence and analyze available data. Results of Laparoscopic surgery is associated with fewer complications and higher efficiency. Laparoscopic Trainer.

Basic Laparoscopy

Basic laparoscopy techniques include: diagnostic procedures, adhesion lysis, cholecystectomy, appendectomy, herniorrhaphy. This laparoscopy is part of the teaching plan in our section and on average residents’ graduate with a minimum number of interventions during their three years.

All residents graduated from 1993, and who are currently practicing. Who obtains their training in basic laparoscopic surgery and more than 85% of the cholecystectomies performed are by this modality? Therefore, we believe that training and authorization to perform basic laparoscopic techniques should no longer be paramount. Laparoscopic Trainer.

Advanced Laparoscopy

To safely perform advanced laparoscopy, in addition to a perfect proficiency in the basic part. A minimum of procedures performed, training in endoscopic sutures. And knotting (intra or extracorporeal). Techniques that are more difficult to perform than similar ones, requires in its open counterpart.

Currently, the most frequently performed advanced procedures are as follows:

  • Choledochotomy,
  • Vagotomy,
  • Enterectomy,
  • Fundoplication,
  • Colectomy,
  • Hysterectomy,
  • Splenectomy,
  • Hepatic surgery,
  • Pancreatic surgery,
  • Different types of thoracic surgery, and more recently,
  • (1996) the neck approach for surgery of endocrine of the thyroid and parathyroid glands.

Adequate Training in Advanced Laparoscopy

Adequate training in advanced laparoscopy, previously not gave attention in resident programs, nor trains surgeons performing basic laparoscopic surgery. An additional factor that complicates the situation is that the open surgery counterpart of these procedures performs less frequently than laparoscopic cholecystectomy.

Obstacles In Training

This represents an obstacle for surgeons who train and manage to overcome the learning curve. Of course, there are skills common to all advanced procedures that reduce the number of each individual procedure that performs to attain the skill.

Additionally, complications resulting from technical errors during the learning curve in advanced laparoscopic surgery. Which are as follows:

  • Pneumothorax,
  • Massive hemorrhage,
  • Gastrointestinal perforations,
  • Bile leaks, etc.

are more frequent and serious than those observed in basic procedures.

Granting Privileges for Laparoscopic Surgery

Criteria for granting privileges to perform advanced laparoscopy should include, first, prior experience in conventional surgery and basic laparoscopy, followed by ulterior and ethical training and work in advanced laparoscopic techniques.

Laboratory Training by Expert Surgeons

Laboratory training with animals provides initial technical experience although supervised testing in humans is essential. This training achieves by completing a master’s program in the hospital itself. And either by inviting expert surgeons from abroad. Or, failing that, by obtaining the training of a surgeon from the service (qualified and with privileges).  And who has previously completed an advanced laparoscopy course. Laparoscopic Trainer.

Who will have the function of acting as preceptor? Due to the inconvenience of achieving an adequate number of supervised cases. The ideal way to obtain the required training will be dedicate a period of training in prestigious university institutions that handle a significant number of cases. Or dedicate a full year to obtain membership.

Advanced Laparoscopy Courses

In the service where the author worked (1990-1999). Several surgeons, each of whom have performed basic laparoscopic procedures. And who completed advanced laparoscopy courses on experimental models. As we visit renowned laparoscopic centers to observe different advanced procedures. Laparoscopic Trainer.

Experience In Advanced Laparoscopic Surgery

This learning experience not carries out acting as surgeons, and it is a preparation that was clearly insufficient.

In view of experience, we believe that there are currently two ways to improve in advanced laparoscopic surgery. As follows:

  • Choosing on merit a surgeon from the service, department, or hospital, to achieve training in advanced laparoscopic surgery in prestigious university centers and obtain the required training in these procedures and once he has become an expert, he will return to the hospital, to collaborate in the education and training of their colleagues.
  • Bring in a preceptor from other renowned institutions to teach and teach enthusiastic surgeons. Unfortunately, this last method is very expensive and inefficient.

The solution implemented in our service was to send the interested surgeons to prepare; and that upon their return they will implement everything necessary to structure the teaching. This professional will collaborate with the training of other surgeons of the service or department.

Evaluation Of the Results

The results in laparoscopic surgery (basic or advanced), as in conventional surgery, must be subject to permanent surveillance by hospital authorities as part of the assessment of the work performed. Laparoscopic Trainer.

It may be necessary to assign preceptors, or require additional training or even restrict some of the privileges granted when high morbidity rates identify.

The surgeon has a personal responsibility to have continuing education and be aware of current information in minimally invasive surgery, because variations in equipment and techniques are frequent and evolve rapidly.

The periodic analysis of morbidity and mortality, as well as the systematic review of the published literature, should serve as a guide for the surgeon, service, or department to determine which is the best evidence, to offer or suppress the procedures.

Conclusions

It is necessary to develop minimally invasive techniques in the chair of surgical technique and that in the different surgery services and their study stimulates and encouraged.

Their learning to encourages today through training cubicles and in laboratory animals, and soon by using state-of -the-art computer programs with sound and animation (multimedia), and virtual reality environments.

We must recognize and support the effort made by the chairs, services and departments in this regard and try to increase the number of teachers committed to their teaching. This is the only way to improve the quality not only of care, but also of teaching and research in universities.

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