Abstract
The learning curve in minimally invasive surgery is much longer than in open surgery. This is thought to be due to the higher demands made on the surgeon's skills. Therefore, the question raised at the outset of training in laparoscopic surgery is how such skills can be acquired by undergoing training outside the bounds of clinical activities to try to shorten the learning curve. Simulation-based training courses are one such model. In 2011, the surgery societies of Germany adopted the "laparoscopic surgery curriculum" as a recommendation for the learning content of systematic training courses for laparoscopic surgery. The curricular structure provides for four 2-day training courses. These courses offer an interrelated content, with each course focusing additionally on specific topics of laparoscopic surgery based on live operations, lectures, and exercises carried out on bio simulators. Between 1st January, 2012 and 31st March, 2016, a total of 36 training courses were conducted at the Vivantes Endoscopic Training Center in accordance with the "laparoscopic surgery curriculum." The training courses were attended by a total of 741 young surgeons and were evaluated as good to very good during continuous evaluation by the participants. Training courses based on the "laparoscopic surgery curriculum" for acquiring skills in laparoscopy are taken up and positively evaluated by young surgeons.
Highlights
The term “learning curve” as currently employed in surgery means that inexperienced surgeons have a longer operating time and a higher complication rate [1]
Zendejas et al [7] demonstrated that laparoscopic techniques can be learned more effectively in a simulation-based training course compared with when learning such techniques only during clinical training
The following key courses are recommended: Course I: Course II: Course III: Course IV: fundamentals of minimally invasive surgery and laparoscopic cholecystectomy (Table 1) endoscopic hernia surgery [total extraperitoneal patch plasty (TEP), transabdominal preperitoneal patch plasty (TAPP), laparoscopic intraperitoneal onlay mesh, and laparoscopic fundoplication] (Table 2) laparoscopic suturing, knot-tying, clipping, stapling, laparoscopic hemostasis, laparoscopic appendectomy, adhesiolysis, stomach wedge resection and gastroenterostomy, and Roux-Y anastomosis (Table 3) laparoscopic colorectal surgery, rectopexy, sigmoid and rectal resection, total mesorectal excision (TME), right hemicolectomy and stoma placement, and intraabdominal intestinal resection (Table 4)
Summary
The term “learning curve” as currently employed in surgery means that inexperienced surgeons have a longer operating time and a higher complication rate [1]. Among the factors militating against rapid acquisition of skills in laparoscopic surgery are the low number of cases suitable for teaching operations, difficulties with the videoeye-hand coordination, altered perceptions of depth, and laparoscopic suturing [8] This means that, often, even after completion of specialist surgical training, some surgeons have shortcomings when it comes to laparoscopic suturing techniques, bimanual coordination, and mastery of challenging anatomic situations [9]. In a prospective randomized trial on learning the total extraperitoneal patch plasty (TEP) technique in endoscopic inguinal hernia surgery, Zendejas et al [16] demonstrated that surgeons who had undergone such simulation-based training had significantly shorter operating times, better performance scores, and fewer intraoperative and postoperative complications than those surgeons who had not taken part in such a training course. Are described the experiences gained in Germany with the introduction of a curricular concept for simulation-based training in minimally invasive surgery, which was offered in parallel to the normal specialist surgical training program
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