Daniel W Birch1, Monali Misra, Forough Farrokhyar. 1. Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, The Department of Surgery, University of Alberta, Edmonton, Alta, Canada. dbirch@ualberta.ca
Abstract
BACKGROUND: This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. METHODS: We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. RESULTS: Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. CONCLUSION: Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons.
BACKGROUND: This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. METHODS: We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. RESULTS: Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. CONCLUSION: Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons.
Authors: T A Kenyon; D R Urbach; J B Speer; B Waterman-Hukari; G F Foraker; P D Hansen; L L Swanström Journal: Surg Endosc Date: 2001-07-05 Impact factor: 4.584
Authors: Sorway W Chan; Chris Hensman; Bruce P Waxman; Stephen Blamey; John Cox; Ken Farrell; Jane Fox; John Gribbin; Laront Layani Journal: ANZ J Surg Date: 2002-07 Impact factor: 1.872
Authors: F Marusch; I Gastinger; C Schneider; H Scheidbach; J Konradt; H P Bruch; L Köhler; E Bärlehner; F Köckerling Journal: Surg Endosc Date: 2001-02 Impact factor: 4.584
Authors: Husein Moloo; Fatima Haggar; Guillaume Martel; Jeremy Grimshaw; Doug Coyle; Ian D Graham; Elham Sabri; Eric C Poulin; Joseph Mamazza; Fady K Balaa; Robin P Boushey Journal: Can J Surg Date: 2009-12 Impact factor: 2.089
Authors: Daniel W Birch; H Jaap Bonjer; Claire Crossley; Gayle Burnett; Chris de Gara; Anthony Gomes; John Hagen; Angus G Maciver; C Dale Mercer; O Neely Panton; Chris M Schlachta; Andy J Smith; Garth L Warnock Journal: Can J Surg Date: 2009-08 Impact factor: 2.089
Authors: Marius Hoogerboord; James Ellsmere; Antonio Caycedo-Marulanda; Carl Brown; Shiva Jayaraman; David Urbach; Sean Cleary Journal: Can J Surg Date: 2019-04-01 Impact factor: 2.089
Authors: Edward P Dominguez; Cory Barrat; Lynn Shaffer; Ryan Gruner; Donald Whisler; Philip Taylor Journal: Surg Endosc Date: 2012-12-12 Impact factor: 4.584
Authors: Hope T Jackson; Sohail R Shah; Emily Hathaway; Evan P Nadler; Richard L Amdur; Shannon McGue; Timothy D Kane Journal: Surg Endosc Date: 2015-10-19 Impact factor: 4.584
Authors: K Freischlag; M Adam; M Turner; J Watson; B Ezekian; P M Schroder; C Mantyh; J Migaly Journal: Surg Endosc Date: 2018-06-26 Impact factor: 4.584