Jul 26

In this era of rapidly changing technology there is great need for good Institute to learn laparoscopic surgery. During early training of medicine in medical school, the lines are drawn between students of the knife and those of the pen. Those of us who did not mind getting our hands dirty with blood and pus went on to the surgical specialties. In spite of the fact that our organs of interest were different, surgical maneuvers for exposure, dissection, tissue approximation, and removal were universal, and we all helped one another and incorporated each other’s techniques. The dictum of, “see one, do one, teach one,” is universally true. If you were a good surgeon, you did not need to prove it by performing the same operation a hundred times in open surgery.  Diversity was the key to excellence– not monotony. Suddenly, the last ten years have brought surgeons to frontiers unfathomable a hundred years ago. Now there is a new generation of surgeons – one not so much of the knife but of the camera. Now you have to chose you want to work with knife or with camera and telescope. While many surgeons become accustomed to the ubiquitous presence of laparoscopy these days, they must not forget that it represents a quantum leap in the way surgery has been performed for thousands of years and it was not a small feat by any means.

Unfortunately there is great need of good training institute of laparoscopic surgery all over world. In the existing institute also trainer themselves are not trained. Most of the trainers dont have any University qualification in Minimal Access Surgery. They themselves are not adequately trained in th basic principles of minimal access surgery. Either they have developed their skill themselves or they have just learn laparoscopic surgery on their patients.

A major barrier against adoption and deployment of laparoscopic training program in developing of countries in the Asia Pacific is the lack of human resources with Minimal Access Surgical skills. On the recomendation of World Association of Laparoscopic Surgeons all over world many pilot program has been started to train the trainers. This pilot programme aims to address the problem by training trainers in countries, so that these trainers in turn will be able to train others and kick start the self-sustaining development of well trained laparoscopic surgeons. World Laparoscopy Hospital, Gurgaon, is one of the Institute recognized to start this program in India. Using an internationally recognized skills standard will also aid the development of reputation of health care industry of any country as it opens the doors to foreign investment and the international market of medical tourism.

Training surgeons to assume this challenge has been problematic in many ways. In particular, the ancient specialty of surgery worthy of mention in the “Hippocratic Oath” has faired poorly in bringing the advantages of laparoscopic surgery into its general fold. Unlike community based physician who were motivated to learn endoscopy, community  have not developed a passion for minimal access surgery. Another problem is that without exposed during residency or fellowship training to laparoscopic surgery, few surgeons and gynecologists are willing to incorporate laparoscopy into their practices.

The fact is that we do not have a single frequently performed laparoscopic operation. There is a great area covered in Minimal Access Surgery. While there may not be one solitary operation to concentrate on, nonetheless, there are several good, classic operations that can be nicely performed laparoscopically. In a good institute the training program is scientifically designed so that surgeon will develop his overall skill and many of these standard procedures have been adapted by academic program to work better laparoscopically and should serve as a motivating factor to encourage the general surgeons, gynaecologists, urologists and pediatric surgeons to perform them. If a surgeon learn to perform with correct principle only few surgery, then these same skills can be used to perform other familiar operations. With practice, more complicated operations, such as laparoscopic whipples procedure and radical hysterectomy might follow.

Gereral surgeons, Gynaecologists. Pediatric surgeons and Urologists who are interested in incorporating laparoscopy into their practices often go out of their way to invest time and money in attending postgraduate training courses in many of the european countries. Shortly thereafter, they find the attendance certificate received at the end of the course is of little help in convincing hospital credentialing committees they can perform laparoscopic operations on their own. If you are the first laparoscopic surgeon in your hospital requesting unsupervised laparoscopy privileges, you will soon encounter a skeptical group of individuals opposing you. Inevitably, the issue of who will proctor you arises. Suggestions have been made that senior consultant general surgeons of professor and associate professor rank are likely candidates to proctor novice laparoscopists in their hospitals. But, this is not in the best interest of either the patients or surgeons involved. It is therefore, unreasonable to expect a senior open surgeon without any experience in laparoscopy to proctor Minimal Access Surgeon.

We must also remember the ever-present specter of litigation in this era of consumer court. Malpractice insurance companies could conceivably refuse to cover general or gynecological laparoscopists proctoring outside of their specialty if they are not trained in well recognized institute.