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| Who Should Give Training In Laparoscopic Training |
| By : Dr.R.K.Mishra | Previous | Next |
| Posted on : 31 Aug, 2008 | Total Views : 393 |
There is a risk in Minimal Access Surgery that it will fall into disrepute unless adequate steps are taken to standardize the training of minimal access surgery. Some form of accreditation after a recognised training scheme would go a long way towards removing fear from patients from these fears. Most of the training institute of the world is giving training for just few days and they are increasing the number of high risk surgeons. About minimal access surgeon it is said the “There are some patient whom we cannot help but there are none whom we cannot harm”. Adequate training will probably pay dividends in reduced the number of these high risk surgeons.
The Medical Council of India should be responsible for maintaining standards of teaching on recognised courses, setting criteria for accreditation, and supervising a national audit of all laparoscopic procedures.
Laparoscopic surgery is now necessity not luxury. The explosion of interest in minimally invasive surgery among surgeons and gynaecologists represents the most dramatic change in surgery. There is little doubt that laparoscopic surgery will progress to dominate all the surgical procedures. As with any highly demanding skill, during learning Minimal Access Surgical procedures take longer and there may be an increased risk to the patient. An increased incidence of iatrogenic bile duct injuries was reported during the introduction of laparoscopic cholecystectomy. Training in laparoscopic surgery should be structured to help people along the learning curve quickly and safely. Along with teaching there should clearly be some form of accreditation. There is necessity to train the trainers. Most of the trainers of Laparoscopic Surgery themselves not have any structured training in Laparoscopy.
The question of accreditation in minimally invasive surgery needs to be addressed urgently. Accreditation should apply not only to senior house officers and registrars but also to consultants. The Medical Council of India makes no attempt to assess manual dexterity at any time in a surgeon's training. The problems that will be with us for the next 10 years is that all presently appointed consultants are predominantly self taught and have varying degrees of skill and expertise. Thus we are back to the thorny issue of accrediting existing consultants.
One of the very interesting issue is that if accreditation is to be introduced, who should be responsible for it to standardized. It would not be difficult for MCI to set up a panel of surgeons experienced in performing and teaching laparoscopic surgery to undertake this task. This could be done in association with the surgical societies with a specific interest in minimally invasive surgery. World Association of Laparoscopic Surgeon has already taken initiative in this field and we requested the MCI to set a pattern.
Internationally criteria for accreditation of Minimal Access Surgery would have to be laid down, and clearly a mechanism of appeal for those who fail accreditation would also need to be organised.
The ideal training for minimal access surgical procedure is, firstly, for trainees to watch a video; if they have no laparoscopic experience, they should spend time on a pelvitrainer before attending a hands-on course. During my Master degree in Minimal Access surgery from University of Dundee my professor, Prof. Cuschieri has estimated that 10% of surgeons will not take up these skills and are thus better confining their activities to open surgery. It is very unlikely that in the immediate future they will find themselves short of trade.
Written By : Dr.R.K.Mishra
