Re: The Impact of Training in Unselected Patients on Mortality and Morbidity in Carotid Endarterectomy in a Vascular Training Center and the Recommendations of the European Board of Surgery Qualification in Vascular Surgery. A Rijbroek, W Wisselink and J A Rauwerda

Abstract

The article by Rijbroek et al.1Rijbroek A. Wisselink W. Rauwerda J.A. The impact of training in unselected patients on mortality and morbidity in carotid endarterectomy in a vascular training center and the recommendations of the European Board of Surgery Qualification in Vascular Surgery.Eur J Vasc Endovasc Surg. 2003; 26: 256-261Google Scholar in the September issue, Volume 26, Number 3 of the EJVES raises some important points regarding the influence of the required number of indicator procedures (carotid endarterectomy) during training, for the adequacy of the vascular surgeon to perform this operation safely. The total of 30 CEAs (15 as first assistant, 10 with supervision and 5 without supervision) were chosen by the European Board of Vascular Surgery (EBVS) as a minimum requirement in order to admit a candidate to the second part (viva voce) of the examination. However, the EBVS feels that merely the number of indicator procedures, although representative of the quantity of experience, has little impact on the quality and thus the outcome, of the procedures.2Liapis C.D. Nachbur B. EBSQ-VASC Examinations – which way to the future?.Eur J Vasc Endovasc Surg. 2001; 21: 473-474Google Scholar In order to overcome this obstacle, the EBVS introduced the Technical Skills Exercise as part of the examination. Up to now, this has been done on a model setting of saphenofemoral ligation and distal infrapopliteal anastomosis. Initial results were presented at the last ESVS Meeting in Dublin in September 2003 and at the VSSGBI 38th Annual Scientific Meeting,3P≻andey&/sc; VA, L≻iapis&/sc; CD, B≻erqvist&/sc; D, W≻olfe&/sc; JHN. On behalf of the European Board of Vascular Surgery: The European Board of Surgery Qualification in Vascular Surgery: Factors affecting the technical skill of examination candidates. (Unpublished data. Abstract presented at VSSGBI 38th Annual Scientific Meeting, Glasgow, Nov 2003).Google Scholar Glasgow in November 2003. We are currently in the process of evaluating the correlation between number of indicator procedures and the results of the technical skills exercise. Question for the authors: did they check the number and severity of cranial nerve injuries in the two groups (trainees versus consultants)? This may be a more sensitive index of the surgeon's dexterity or familiarity with the region, than stroke and death.