Advanced Laparoscopic Skills Acquisition: The Case of Laparoscopic Colorectal Surgery
Section snippets
Historical context
It has been almost 20 years since the introduction of laparoscopic cholecystectomy by Eric Mühe [1] and Philippe Mouret [2] in the early 1990s, and it changed the face of surgery forever. Since then, the development and validation of advanced end-organ and intestinal minimally invasive procedures have occupied an ever-increasing place in the surgical literature [3], [4], [5], [6], [7], [8]. Moreover, multiple randomized trials have demonstrated the superiority of laparoscopic colon resection
Basic principles of technical skill acquisition
Unfortunately, many teachers of surgery in the past have downplayed the technical aspect of surgery while trying to highlight the importance of sound surgical judgment, cognitive knowledge, and decision-making capability—“…you can train a monkey to operate.” With the advent of advanced laparoscopic procedures, it has become evident that the difficulty of acquiring the technical skill aspect of surgery has been underestimated [18]. Although it is beyond the scope of this article to review all
Educational strategies
Advanced laparoscopic surgery is a highly intellectual activity that involves the processing of perceptual information that is received from proprioceptive, visual, tactile, olfactory, and auditory sources. DesCôteaux and colleagues [26] have suggested three strategies to help learners process, organize, and retain perceptual information: imagery, mental practice, and systematic review of performance.
The MIS mindset
Medicine, the only profession that labors incessantly to destroy the reason for its existence.
James Bryce, British historian (1838–1922)
In the past 2 decades, the use of the least aggressive treatment that provides equivalent or better outcomes for the patient has been a clear direction of surgical therapy in all specialties. Although this vision still may seem utopian for some, it certainly depicts the philosophy of MIS surgeons, who, in every case, try to use the least aggressive approach to
Skill sets more specific to advanced laparoscopic surgery
Several problems need to be addressed for the adequate performance of advanced laparoscopic procedures, and most advanced laparoscopists of the first generation often have learned the hard way. Laparoscopic surgery is based foremost on the prophylaxis of any errors. One cannot cut corners in laparoscopic surgery, and patience is paramount. This surgery is not for impatient surgeons.
Some skills that seem to define advanced laparoscopic surgery are reviewed. Because many laparoscopic skills are
Skills laboratory and simulators
Skills and simulation laboratories have proliferated in the teaching environment of academic health sciences centers over the last few years. With regards to laparoscopic skills they offer an introduction to basic MIS skills with a spectrum of tools that ranges from box trainers to virtual reality simulators. They have been shown to improve operating room performance in basic laparoscopic procedures (eg, laparoscopic cholecystectomy), and are useful in introducing learners to laparoscopic
Summary
Acquisition of advanced technical skills requires commitment, time, patience, and discipline (eg, the 10-year rule). Dabbling is not a recipe for success.
Despite the value of all other teaching methods, guided practice with feedback is essential to develop the high level of visuospatial perceptual ability (observation and performance with feedback) that is necessary for advanced MIS.
The necessary ingredients to skill acquisition for advanced MIS procedures (laparoscopic colorectal surgery) for
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Cited by (17)
Training for Minimally Invasive Cancer Surgery
2019, Surgical Oncology Clinics of North AmericaCitation Excerpt :The sense of urgency to acquire MIS skills has spurred the development of many fellowship and short-course training programs, and a rapid advancement of training technology options. Since Frederich Greene told the World Congress of Laparoscopic Surgery in 1998, ‘‘The capacity of American surgery to adequately teach advanced minimally invasive surgery is simply overwhelmed,’’1 how far has the field come? Throughout the literature are exciting examples of how specialists and generalists alike are working to overcome the educational challenges of this rapid evolution.
Core Competencies for Gynecologic Endoscopy in Residency Training: A National Consensus Project
2009, Journal of Minimally Invasive GynecologyCitation Excerpt :Nevertheless, the creation of a surgical curriculum for laparoscopy and hysteroscopy will offer our trainees the necessary road map to attain cognitive knowledge and develop technical skills while providing guidance to clinical teachers for determining educational milestones. When endoscopic teaching is based on a structured and comprehensive curriculum, skills and outcomes are improved [24–27]. Growing evidence also suggests that formal laparoscopic training of gynecology residents also improves patient outcomes [26].
The Role of Simulation in Surgical Continuing Medical Education
2008, Seminars in Colon and Rectal SurgeryCitation Excerpt :Transfer of training has been the focus of considerable research outside of surgery69,70 and knowledge gained in this research could serve as the starting point to understand how to create the optimal transfer of training from surgical CME to surgical practice.71
Assessing the impact of a 2-day laparoscopic intestinal workshop
2011, Canadian Journal of SurgeryAdvanced laparoscopic training and outcomes in laparoscopic cholecystectomy
2009, Canadian Journal of Surgery