Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Abstract

Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

“…Bailout strategies when a laparoscopic approach does not allow completion of the operation have not been studied as often. Additionally, several EGS programs have been using and reporting their outcomes after robotic surgery in the management of EGS diseases [ 11 ] Laparoscopic surgery bailout approaches in difficult EGS cases: Is the open approach the only option? Comparison between the laparoscopic and robotic approaches in the management of specific General Surgical emergencies How to implement a robotic surgery program to manage EGS diseases?…”

“…These studies would ideally focus on underexplored elements of EGS patient care including, but not limited to, triggers for conversion to an open procedure, complication frequency, time to restoration of gastrointestinal function, iatrogenic injury incidence and intra-operative recognition techniques, and what factors influence outcomes in those who require critical care. Regionalization for MIS in EGS patients may be also worthwhile to explore as outcomes may be related to surgeon preferences, skill sets and thereforebiases [ 11 , 58 ]. Additionally, it is imperative to explore patient-reported outcomes (PROMs) during the in-hospital phase, as well as their long-term impact on post-convalescence quality-of-life.…”

A Low Cost Emergency Laparotomy Task Trainer for Major Abdominal Bleeding: An Option for Surgical Residents to Learn Lifesaving Basic Surgical Skills

“…Evidence on assessing the proficiency of a trainee in emergency procedures is scarce. 16 Due to the introductory nature of the training, technical skills were not individually surveyed in self assessments. Therefore, correlations between objective evaluations on technical skills and self assessments were not computed in this study.…”

Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours

“…In a 2023 review article by the World Society of Emergency Surgery, the authors noted that access is very limited for surgeons performing emergency procedures in general, let alone weekends and evenings [ 8 ]. Sudan et al published two cases of robotic surgery to rescue patients from complications of bariatric surgery, a gastrointestinal leak at midnight, and a stricturoplasty on the weekend [ 9 ].…”