Advanced Minimally Invasive Surgery Research Articles

Experts in Minimally Invasive Surgery are Outperformed by Trained Novices on Suturing Skills

IntroductionLearning minimally invasive suturing can be challenging, creating a barrier to further implementation, especially with the development of easier methods. Nevertheless, mastering intracorporeal knot tying is crucial when alternative techniques prove inadequate. Therefore, the minimally invasive surgery (MIS) suturing skills of MIS experts are compared with a group of novices during their learning curve on a simulator. MethodsThe novice participants repeatedly performed the intracorporeal suturing task on the EoSim MIS simulator (up to a maximum of 20 repetitions). The experts (>50 MIS procedures and advanced MIS experience) completed the same task once. The first and last exercises of the novices and the expert tasks were all blindly recorded and assessed by two independent assessors using the Laparoscopic Suturing Competency Assessment Tool (LS-CAT). Additionally, objective assessment parameters, “time” and “distance”, using instrument tracking, were collected. The scores of the experts were then compared with the novices. ResultsAt the end of the training, novices significantly outperformed the experts on both the expert assessment (LS-CAT: 16.8 versus 26.8, P = 0.001) and objective parameters (median time: 190 s versus 161 s, P < 0.001; median distance: 6.1 m versus 3.6 m, P < 0.001). Although the experts showed slightly better performance than the novices during their first task, the difference was not significant on the expert assessment (LS-CAT experts 16.8, novices 20.5, P = 0.057). ConclusionsOur findings underscore the significance of continued MIS suturing training for both residents and surgeons. In this study, trained novices demonstrated a significant outperformance of experts on both quantitative and qualitative outcome parameters within a simulated setting.

What is MIS fellowship? Community and academic program experience.

Minimally invasive surgery (MIS) fellowship is one of the most popular fellowship programs, but little is known about the individual fellow's clinical experience. Our goal was to determine the differences in case volume and case type in academic and community programs. A retrospective review of advanced gastrointestinal, MIS, foregut, or bariatric fellowship cases logged into the Fellowship Council directory of fellowships during the 2020 and 2021 academic years included for analysis. The final cohort included 57,324 cases from all fellowship programs, that list data on the Fellowship Council website, including 58 academic programs and 62 community-based programs. All comparisons between groups were completed using Student's t-test. The mean number of cases logged during a fellowship year was 477.7 ± 149.9 with similar case numbers in academic and community programs, 462.5 ± 115.0 and 491.9 ± 176.2 respectively (p = 0.28). The mean data is illustrated in Fig.1. The most common performed cases were in the following categories: bariatric surgery (149.8 ± 86.9 cases), endoscopy (111.1 ± 86.4 cases), hernia (68.0 ± 57.7 cases) and foregut (62.8 ± 37.3 cases). In these case-type categories, no significant differences in case volume were found between academic and community-based MIS fellowship programs. However, community-based programs had significantly more case experience compared to academic programs in all of the less commonly performed case-type categories: appendix 7.8 ± 12.8 vs 4.6 ± 5.1 cases (p = 0.08), colon 16.1 ± 20.7 vs 6.8 ± 11.7 cases (p = 0.003), hepato-pancreatic-biliary 46.9 ± 50.8 vs 32.5 ± 18.5 cases (p = 0.04), peritoneum 11.7 ± 16.0 vs 7.0 ± 7.6 cases (p = 0.04), and small bowel 11.9 ± 9.6 vs 8.8 ± 5.9 cases (p = 0.03). MIS fellowship has been a well-established fellowship program under the Fellowship Council guideline. In our study, we aimed to identify the categories of fellowship training and the perspective case volumes in academic vs community setting. We conclude that fellowship training experience is similar in case volumes of commonly performed cases when comparing academic and community programs. However, there is substantial variability in the operative experience among MIS fellowship programs. Further study is necessary to identify the quality of fellowship training experience.

Canadian coaching program leads to successful transition from open to laparoscopic HPB surgery

Background: While laparoscopic techniques for Hepatopancreatobiliary (HPB) surgery emerged in the 1990s, the adoption of minimally invasive surgery (MIS) in this field has been slow. MIS HPB procedures can be technically challenging and associated with learning curves. Surgical coaching is a growing concept in the field of continuous professional development. We discuss a unique, interactive coaching program aimed for practicing HPB surgeons who wished to introduce advanced MIS skills. We aim to explore the perception of coaching among these surgeons, to assess surgeons’ experience in the coaching program, and to explore the role of coaching in the uptake of MIS in the field of HPB.

Distance mentoring in advanced minimally invasive surgery in the Caribbean: A model for low-resource environments

Advanced minimally invasive surgery (MIS) is not universally available in the Anglophone Caribbean, partly due to a shortage of trained laparoscopic surgeons. However, we have witnessed new opportunities for MIS advancement as we enter a period of rapid change in healthcare education. In this paper, we discuss the concept of distance mentoring and the opportunities to promote advanced MIS in the Caribbean. We believe that, if carefully and effectively administered, distance mentoring has the potential for widespread utility, but it requires a change in institutional and medical culture from direct personal training to one that also actively supports distance mentoring.

Ten Year Trends in Minimally Invasive Surgery Fellowship.

Background:Minimally Invasive Surgery (MIS) is one of the more recently established surgical fellowships, with many candidates applying due to a perception of inadequate exposure to advanced MIS during residency. The desire for advanced training should be reflected in increased competitiveness for fellowship positions. The aim of this study is to determine the desirability of MIS fellowships over time through review of national application data.Methods:We reviewed the fellowship match statistics obtained from The Fellowship Council, the organizing body behind the MIS fellowship match. Data from January 1, 2008 – December 31, 2019 were included. We compared match rates to other specialties using the National Resident Matching Program, a nonprofit organization established for US residency and some fellowship programs.Results:In the period of 2008 to 2019, the number of certified MIS fellowship programs increased from 124 to 141. While this program expansion was associated with a 19% increase in available positions, the number of applications increased 36%. As a result, the number of positions filled increased from 83% to 97%, but the match rate among US applicants fell from 82% to 71% during this interval. In comparison, the match rates for pediatric surgery, surgical oncology, vascular surgery, and surgical critical care fellowships remained largely unchanged, most recently 50%, 56%, 99%, and 100% respectively.Conclusion:Over the last decade, US residents have shown an increased interest in pursuing MIS fellowship positions. As a consequence, the match process for MIS fellowships is becoming increasingly competitive.

The MISDEF2 algorithm: an updated algorithm for patient selection in minimally invasive deformity surgery.

Minimally invasive surgery (MIS) can be used as an alternative or adjunct to traditional open techniques for the treatment of patients with adult spinal deformity. Recent advances in MIS techniques, including advanced anterior approaches, have increased the range of candidates for MIS deformity surgery. The minimally invasive spinal deformity surgery (MISDEF2) algorithm was created to provide an updated framework for decision-making when considering MIS techniques in correction of adult spinal deformity. A modified algorithm was developed that incorporates a patient's preoperative radiographic parameters and leads to one of 4 general plans ranging from basic to advanced MIS techniques to open deformity surgery with osteotomies. The authors surveyed 14 fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 24 cases to establish interobserver reliability. They then re-surveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and analyzed. Correlation values were determined using SPSS software. Over a 3-month period, 14 fellowship-trained deformity surgeons completed the surveys. Responses for MISDEF2 algorithm case review demonstrated an interobserver kappa of 0.85 for the first round of surveys and an interobserver kappa of 0.82 for the second round of surveys, consistent with substantial agreement. In at least 7 cases, there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.8. The MISDEF2 algorithm was found to have substantial inter- and intraobserver agreement. The MISDEF2 algorithm incorporates recent advances in MIS surgery. The use of the MISDEF2 algorithm provides reliable guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity.

IPEG 2018The 27th Annual Congress for Endosurgery in ChildrenApril 11–14, 2018, Seattle, Washington

IPEG 2018The 27^th Annual Congress for Endosurgery in ChildrenApril 11–14, 2018, Seattle, Washington

Minimally invasive surgical exposure among US and Canadian pediatric surgery trainees, 2004-2016

BackgroundMinimally invasive pediatric surgery has increased in breadth and complexity over the past several decades, with little data on minimally invasive surgery (MIS) training in US and Canadian pediatric surgery fellowship programs. MethodsWe performed a time series analysis of Accreditation Council for Graduate Medical Education pediatric surgery fellow case logs from 2003 to 2016. Proportions of cases performed in an MIS fashion as well as per-fellow MIS case averages were recorded over time. ResultsThere was a 30.9% increase in average number of MIS cases per fellow over the study time period. Twenty-three recorded procedures included MIS and open options (17 abdominal, three thoracic, and three genitourinary). The proportion of cases performed using a minimally invasive approach increased by an average of 29.0%, 14.6%, and 47.0% for each of these categories, respectively. Significant variability was observed in specific cases such as laparoscopic and open inguinal hernias, ranging from 0 to 85 and nine to 152 per trainee, respectively, in the final year of data collection. When examining pyloromyotomy, a high-volume procedure with a known increase in the MIS approach, the proportion of cases performed MIS increased by 83.3%. The minimum and maximum number of cases per fellow recorded ranged from 0 to 114 during the eight years in which MIS pyloromyotomy was recorded. ConclusionsMIS case exposure among graduating US and Canadian pediatric survey fellows increased substantially during the study period. More granular data, however, are needed to better define the current operative experience and criteria for determination of competency in advanced MIS.

The Case for Simulation-Based Mastery Learning Education Courses for Practicing Surgeons.

Pediatric surgeons rely on simulation courses to develop skills for safe minimally invasive repair of complex congenital anomalies. The majority of minimally invasive surgery (MIS) training courses occur during short "exposure courses" at annual conferences. Little data are available to support the benefit of these courses relative to the safe implementation of new skills. The purpose of this article is to determine the impact of an exposure course for advanced neonatal MIS on self-perceived comfort levels with independent performance of advanced MISs. Participants of a 4-hour hands-on course for neonatal MIS were surveyed regarding clinical practices and pre- and post-training perceived "comfort levels" of MIS skills for thoracoscopic esophageal atresia with tracheoesophageal fistula (tTEF) repair, thoracoscopic left upper lobe pulmonary lobectomy (tLobe), and laparoscopic duodenal atresia (lapDA) repair. Descriptive analyses were performed. Seventeen participants completed pre- and postcourse surveys. The majority of participants had no prior experience with tLobe (59%) or lapDA (53%), and 35% had no experience with tTEF repair. Similarly, the majority were "not comfortable" with these procedures. After the short course, the majority of surgeons reported that they were "likely to perform" these operations within 6 months, despite low levels of baseline experience and comfort levels. An exposure training course led to immediate perception of increased skills and confidence. However, these courses typically do not provide basic tenets of expert performance that demands deliberate practice. Future course design should transition to a mastery learning framework wherein regular skill assessments, milestones, and unlimited education time are prioritized before implementation of the new skills.

What are the Training Gaps for Acquiring Laparoscopic Suturing Skills?

Advanced laparoscopic suturing is considered a challenging skill to acquire. The aim of this study was to investigate the learning process for advanced laparoscopic suturing in the operating room to understand the obstacles trainees face when trying to master the skill. A qualitative methodology using semistructured interviews and field observations was used. Data were analyzed using a Grounded Theory approach. Participants were general surgery residents and surgeons with advanced minimally invasive surgery (MIS) experience. Ten MIS surgeons across different institutions and 15 local general surgery residents were interviewed. The semistructured interviews and field observations of 9 advanced MIS operations (27h) yielded the following 6 themes around the acquisition of laparoscopic suturing skills for residents: complexity, training misalignment, variability of opportunities, inconsistency of techniques, lack of feedback, and differing expectations. There are several unmet training needs around laparoscopic suturing skills. Training for advanced laparoscopic skills requires more emphasis on coaching and the development of advanced models. This study heralded the need to incorporate advanced laparoscopic skills into the surgical simulation curriculum.

Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses.

Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees. After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data. Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely. Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.

The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period.

Although minimally invasive surgery (MIS) has been quickly embraced, the introduction of advanced procedures appears more complex. We assessed the evolution of MIS in the province of Quebec over a 5-year period to identify areas for improvement in the modern surgical era. We developed, test-piloted and conducted a self-administered questionnaire among Quebec general surgeons in 2007 and 2012 to examine stated MIS practice, MIS training and barriers and facilitators to the use of MIS. Response rates were 51.3% (251 of 489) in 2007 and 31.3% (153 of 491) in 2012. A significant increase was observed for performance of most advanced MIS procedures, especially for colectomy for benign (66.0% v. 84.3%, p < 0,001) and malignant diseases (43.3% v. 77.8%, p < 0,001) and for rectal surgery for malignancy (21.0% v. 54.6%, p < 0.001). More surgeons practised 3 or more advanced MIS procedures in 2012 than in 2007 (82.3% v. 64.3%, p < 0,001). At multivariate analysis, the 2007 survey administration was associated with fewer surgeons practising advanced MIS (odds ratio 0.13, 95% confidence interval 0.06-0.29). In 2012, more respondents stated they gained their skills during residency (p = 0.028). From 2007 to 2012 there was a significant increase in advanced MIS procedures practised by general surgeons in Québec. This technique appears well established in current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development. Results from this study could be used as a baseline for studies focusing on ways to further improve the MIS practice.

Utilization of a novel unidirectional knotless suture during minimal access procedures in pediatric surgery

BackgroundThe application of minimally invasive surgery (MIS) for advanced procedures in children is logical. However, the intracorporeal placement and tying of suture can be challenging, leading to prolonged anesthesia and morbidity. We describe our initial experience with the use of a novel unidirectional barbed knotless suture (V-LOC, Covidien, Mansfield, MA) that permits a safe and efficient advanced MIS reconstruction in infants and children. MethodsFrom August 2010 to February 2012, 11 infants and children underwent diaphragmatic reconstruction utilizing either the absorbable or the permanent V-LOC suture. Data retrieval included gender, weight, diagnosis, operative time, complications and follow up. ResultsThoracoscopic or laparoscopic repairs were carried out in all children. Two of the infants with congenital diaphragmatic hernia of Bochdalek (CDH) developed a recurrence at 4 and 6months of age and required reoperation. There were no other complications or recurrence in the remaining 9 children, and there were no mortalities in the group. ConclusionThis is the first study to evaluate the use of the unidirectional barbed knotless suture in pediatric surgery. We demonstrate that the use of the V-LOC barbed suture is an innovative, safe and time saving option for pediatric MIS. Prospective analysis with long-term follow-up is required to confirm these initial results and to ascertain if this novel approach can be utilized in other pediatric surgical conditions.

Initial experience with laparoscopic hepatic resection at a comprehensive cancer center

Over the past few years, surgeons have been able to obtain training in advanced minimally invasive surgery (MIS) for hepatic, pancreatic, and biliary (HPB) cases instead of having to teach themselves these complex techniques. As a result, the initial experience of a surgeon with advanced MIS HPB training at a national cancer center was reviewed. The experience of a surgeon with the first 50 laparoscopic hepatectomies for cancer was reviewed retrospectively. All cases begun with the intention to complete the hepatectomy laparoscopically were included in the laparoscopic group. From November 2008 to October 2010, a total of 57 hepatectomies were performed, with 53 attempted laparoscopically. Of these 57 hepatectomies, 46 (87%) were completed laparoscopically, 4 (7%) required hand assistance, and 3 (6%) were converted to an open approach. Laparoscopic minor hepatectomies were performed for 28 patients and laparoscopic major hepatectomies for 25 patients. The mean operative time was 265 min, and the mean estimated blood loss was 300 ml. The mean hospital stay was 7 days. Complications occurred for six patients (11%) (2 bile leaks, 2 hemorrhages requiring conversion, 1 hernia requiring a hernia repair on postoperative day 7, and 1 ileus managed nonoperatively). Surgeons with advanced MIS HPB training may be able to perform a higher percentage of their hepatectomies laparoscopically. Training in both open and laparoscopic HPB surgery is advisable before these techniques are performed.

A structured strategy to combine education for advanced MIS training in surgical oncology training programs

Changing realities in surgery and surgical technique have heightened the need for agile adaptation in training programs. Current guidelines reflect the growing acceptance and adoption of the use of minimally invasive surgery (MIS) in oncology. North American general surgery residents are often not adequately skilled in advanced laparoscopic surgery skills at the completion of their residency. Presently, advanced laparoscopic surgery training during surgical oncology fellowship training occurs on an ad-hoc basis in many surgical oncology programs. We present a rational and template for a structured training in advanced minimally invasive surgical techniques during surgical oncology fellowship training. The structure of the program seeks to incorporate evidence-based strategies in MIS training from a comprehensive review of the literature, while maintaining essential elements of rigorous surgical oncology training. Fellows in this stream will train and certify in the Fundamentals of Laparoscopic Surgery (FLS) course. Fellows will participate in the didactic oncology seminar series continuously throughout the 27 months training period. Fellows will complete one full year of dedicated MIS training, followed by 15 months of surgical oncology training. Minimal standards for case volume will be expected for MIS cases and training will be tailored to meet the career goals of the fellows. We propose that a formalized MIS-Surgical Oncology Fellowship will allow trainees to benefit from an effective training curriculum and furthermore, that will allow for graduates to lead in a cancer surgery milieu increasingly focused on minimally invasive approaches.

Are Minimally Invasive Procedures Harder to Acquire than Conventional Surgical Procedures?

Background: It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents’ learning curves of both surgical skills are compared. Methods: Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery. Results: Nine postgraduate-year-4 residents collected a total of 319 OSATS during the 2 years and 3 months investigation period. These assessments concerned 129 MIS (laparoscopic and hysteroscopic) and 190 conventional (open abdominal and vaginal) procedures. Learning curves (in this study defined as OSATS score plotted against procedure-specific caseload) for MIS and conventional surgery were compared using a linear mixed model. The MIS curve revealed to be steeper than the conventional curve (1.77 vs. 0.75 OSATS points per assessed procedure; 95% CI 1.19–2.35 vs. 0.15–1.35, p < 0.01). Conclusions: Basic MIS procedures do not seem harder to acquire during residency than conventional surgical procedures. This may have resulted from the incorporation of structured MIS training programs in residency. Hopefully, this will lead to a more successful implementation of the advanced MIS procedures.

Resident training in minimally invasive surgery: a survey of Canadian department and division chairs

This study aimed to seek the opinions of academic surgical chairs on minimally invasive surgery (MIS) education for general surgery residents and to identify perceived gaps and trends in educational strategies. A national survey on attitudes toward MIS was sent to the chairs of departments of surgery and divisions of general surgery across the 16 Canadian academic centers. The survey contained 34 questions consisting of Likert scales, single answers, and multiple-choice questions. Nonresponders were contacted directly. At the time of the survey, two department chair positions were vacant. The response rate was 87% (26/30). The majority of the centers used early operating room exposure to basic MIS cases (92%) and animal labs (85%). Two-thirds of the institutions used early operating room exposure to advanced MIS cases (69%) and didactic lectures (65%). Half of the academic centers used MIS video (54%) and the laparoscopic virtual reality simulator (54%). The least used method was computer software (19%). The surgical division and department chairs believed the most effective teaching method was early operating room exposure to basic MIS cases (100%), followed by the laparoscopic virtual reality simulator (91%) and animal labs (88%). Computer software was considered 42% useful, and the least useful method was didactic lectures (16%). In the next 5 years, 62% of academic centers plan to add laparoscopic virtual reality simulators to their MIS curriculum. The chairs' opinion on the most effective MIS teaching method for residents is basic MIS cases followed by laparoscopic virtual reality simulators. The majority of academic institutions plan to add laparoscopic virtual reality simulators to the curriculum in the next 5 years.

Laparoscopy influences hiring practices within academic surgical departments

This study aimed to determine whether the increasing emphasis on minimally invasive surgery (MIS) influences hiring practices within academic surgical departments. A questionnaire was mailed to chairs of surgery departments and divisions of general surgery at the 16 Canadian academic institutions. Nonresponders were identified and contacted directly. The survey consisted of 34 questions, including Likert scales, single answers, and multiple-choice questions. Data were collected on demographics, perceptions of MIS, and recruitment/hiring. At the time of the survey, two department chair positions were vacant. A response rate of 87% (26/30) was obtained, with representation from 94% of departments (15/16). Of those surveyed, 88% intend to increase the importance of MIS at their institution within 5 years, and 87% intend to achieve this objective through new hirings. Networking (73%) and retention of recent graduates (89%) were cited most frequently as recruitment strategies. Strengthening the division, research, and education were considered important or extremely important by more than 90% of the respondents with respect to recruitment goals, whereas strengthening MIS was considered important or extremely important by 50%. Within 5 years, surgical departments intend to hire a median of four general surgeons, 50% of whom will have formal MIS training. In comparison, over the past 10 years, only 25% of new recruits had formal MIS training. More than 90% of the respondents considered formal MIS fellowship, MIS fellowship plus a second fellowship, and proctorship to be adequate training for performing advanced MIS, whereas traditional methods were considered inadequate. Lack of operative time and resource issues were considered most limiting in the hiring of new MIS surgeons. Minimally invasive surgery is growing in importance within academic surgical departments, but it remains an intermediate recruitment priority. Formal MIS training appears to be important in the recruiting of new surgeons, whereas traditional training methods are considered inadequate.

Broad-Based Fellowships: A Cornerstone of Minimally Invasive Surgery Education and Dissemination

Aware of the trends in surgery and of public demand, many residents completing a 5-year training program seek fellowships in minimally invasive surgery (MIS) because of inadequate exposure to advanced MIS during their residency. A survey was designed to evaluate the effectiveness of a broad-based fellowship in advanced laparoscopic surgery offered in an academic health science center. The questionnaire was mailed to all graduates. Data on demographics, comfort level with specific laparoscopic procedures, and opinions regarding the best methods of acquiring these skills were collected. Most of the surgeons entered the fellowship directly after residency. The majority of these surgeons are academic surgeons. Fellows performed a median of 187 cases by the end of their training and felt comfortable operating on foregut, hindgut, and end organ. A full year of training was found to be the best format for appropriate skill transfer. A broad-based MIS fellowship meets the needs of both academic and community surgeons desiring to perform advanced laparoscopic procedures.

The impact of a formal mentoring program for minimally invasive surgery on surgeon practice and patient outcomes

Background Surgeons need a process by which to safely introduce new procedures, such as minimally invasive surgery (MIS), into practice. Emerging evidence would suggest that an effective strategy is the implementation of a mentorship program. This study analyzed the effect of mentoring on a single institution’s advanced MIS practice. Methods We analyzed clinical outcomes by completing a retrospective review of patient charts 1 year before and 1 year after the recruitment of a fellowship-trained advanced MIS surgeon in July 2004 whose job description included facilitating the introduction of advanced gastrointestinal MIS. Results A total of 7 general surgeons were mentored at 1 site. After 1 year of intense mentoring, the number of surgeons completing >12 cases/y increased from 2 to 4, and the number of advanced MIS cases completed (excluding mentored ones) increased from 35 to 102. Fifty-three cases (52% of total) were formally mentored. Total conversions to open surgery decreased from 14.3% to 6.4% ( P = .12). The number of colorectal resections increased from 11 to 92 ( P = .0027). Intraoperative complications were not significantly decreased, eg, from 17.1% to 7.1% ( P = .06). Postoperative complications remained unchanged (15.0% to 16.5%). Conclusions Surgeons and the institutions in which they work have a duty to adopt advanced MIS techniques in a safe and appropriate manner. We believe our data demonstrate that a mentorship program is an effective strategy for safely introducing advanced MIS into practice.