Training for laparoscopic surgery.

Laparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of the training program at the University of Maryland since 1989. Currently, residents who are completing their training have performed on average 50 to 75 laparoscopic procedures as the primary surgeon and 25 to 30 as the first assistant. In addition to training future community and academic physicians, those surgeons currently in practice must receive appropriate instruction in laparoscopic surgery. Most practicing surgeons attend a 2- to 3-day intensive course offering both didactic and hands-on experience. Additional exposure to clinical cases is achieved by working with other surgeons with laparoscopic expertise. Full credentialing in laparoscopic cholecystectomy generally requires proctoring by a surgeon from the local community. Since 1990 faculty from the University of Maryland have been active in the local community serving as proctors to surgeons in 14 hospitals.