Minimally Invasive Surgery (Laparoscopy) and Surgery Challenges

 

Lifestyle of General Surgeons

Studies carried out in some of these countries show that the origin of not opting for general surgery is related to what they call the "lifestyle" of general surgeons, due to excessive workload, surgical stress, nocturnal work, the increase in the demand for quality and legal demands, among other aspects. For minimally invasive surgery technique many of them have not received practical training with simulators resembling Lap Trainer Box.

The workload produced by the aging of the population is an important factor and cannot be seen only from a quantitative point of view, as it has a substantial qualitative component. It is pointed out that in the population would grow from but that due to the increase in its aging, the workload of the general surgeon -due to the greater demand for surgical activity and care- it would grow in the same period by 31.5%. The head of the Surgical Society in 2008 reported that the number of general surgeons in his country had decreased in the last 8 years by 6%.

Structuring Conference

Due to the growing shortage of surgeons that can be seen and their increasing age, some North American authors propose formulas to motivate medical students to opt for residency in general surgery. In our country there are no published works that have studied in depth this situation in our specialty.

In the future, our residents, in addition to carrying out their usual activities, will have to dedicate more time to the study of new technology and to obtain manual skills in simulators, so it would be fair to give them a greater number of conferences and seminars that facilitate the possibility of acquiring theoretical knowledge without having to take more hours off rest and free time. Although with different objectives, some authors already expose their experiences and the importance of structuring conference programs with a suitable organization of teaching activities and the search for appropriate hours that facilitate the attendance of all residents to them.

Continuing Education

Accreditation in basic laparoscopic surgery postgraduate courses has generally been carried out with an average duration of two months, during which specialists receive theoretical-practical knowledge and create their skills with direct participation in surgical interventions, starting as a second assistant, then cameraman and at the end they perform a few cholecystectomies, as few centers have simulators for teaching.

As there is no uniform accreditation program throughout the country, these are drawn up according to the criteria of the group that teaches it. Nor are the evaluation systems uniform, nor the number of interventions that must be carried out to obtain accreditation. Therefore, it is important to seek consistency so that surgeons across the nation will possess similar theoretical knowledge and manual skills upon completion.

Training in Basic Laparoscopy

Training in basic laparoscopic surgery at postgraduate level will have to diminish or disappear over time when specialists who have not yet done so have been trained and residents graduate with an adequate mastery of the technique; but at the same time that this happens, postgraduate courses in advanced surgery should be increased.

At the present time, it is important to continue in the different services the training of specialists who are not yet prepared, prioritizing those who have the teaching category, in order to face the residency study programs that lie ahead.

According to the Health Yearbook, if the first 4 years of consolidation of the technique are excluded, since to date general surgery specialists have graduated, under the conditions described above. They have concluded their career with a greater or lesser level of technical deficiencies in bile duct surgery, which should be a reason for investigation, with the aim of solving them.

Development of Advanced Laparoscopic Surgery

Although it is true that interventions such as laparoscopic cholecystectomy can be performed in most patients on an outpatient basis or with a short stay. As has been carried out for years in most hospitals, there is an erroneous appreciation of this approach, not only in the population but even in some non-surgical specialty doctors due to the lack of adequate information and, perhaps also, due to the influence of what its name translates: «minimally invasive surgery»; "Minimal access surgery."

However, surgeons know that its advantages lie mainly in the postoperative period, since laparoscopic surgical techniques are generally more difficult to perform than open surgery, surgical time is longer and anesthesia is much more complex due to pneumoperitoneum. This is increased in advanced laparoscopic surgery by addressing larger surgeries with more difficult surgical techniques to perform, which entail longer surgical time and in conditions with higher morbidity and mortality rates.

The development of advanced laparoscopic surgery should be supported by the different areas of interest, which is a primary factor for the general progress of the specialty, since its advantages in open surgery have already been demonstrated and morbidity has decreased and patient mortality.

Conventional Surgery

If we recall the first years of incorporating laparoscopic surgery in our hospitals, we will remember that it was common for surgeons who had training in the technique saw specialists with experience and results in certain areas go to of interest, and sometimes to coloproctologists, so that we can perform laparoscopic surgical procedures on their patients, for the sole fact that they were not trained in this new approach. This situation has not yet disappeared.

In the same way that happens in conventional surgery, it is not possible to develop a laparoscopic surgical intervention with maximum efficiency and safety, if it is not performed in specific conditions by surgeons who have perfected the surgical technique, have skills, experience and accumulated theoretical knowledge due to his dedication to them.

It is unquestionable and no one doubts that it is easier, it is achieved in a shorter time, it is less expensive and more quality is provided, if a liver surgeon is trained in the techniques of minimal access surgery to perform laparoscopic interventions in the liver, which, on the contrary, would train a surgeon who has mastery of this approach in liver surgery; but that he has no experience in the surgery of this organ.

After having directed a general surgery service for years and having had training in this technology from the beginning, I know from my own experience that the "attractiveness" and "neatness" of this approach would be "dearest" with the surgeon who performs it, who you want to experiment in everything without realizing that others can do better.

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