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Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper. | LitMetric

AI Article Synopsis

  • Minimally invasive surgery (MIS) is becoming increasingly popular in planned digestive surgeries but is less common in emergencies; this paper reviews the learning curve for proficiency in emergency MIS and suggests guidelines for training.
  • A review of thirteen studies indicates that proficiency in emergency laparoscopic procedures typically requires performing about 30 surgeries, but this varies with the surgeon's experience; there's a call for more research in this area.
  • The paper advocates for a structured training approach that includes simulations and supervised practice to improve proficiency in emergency MIS and highlights the need for ongoing assessment and team involvement in the training process.

Article Abstract

Background: Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.

Methods: This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements.

Results: Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency.

Conclusions: Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883976PMC
http://dx.doi.org/10.1186/s13017-023-00476-wDOI Listing

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