Education And Debate

Teaching laparoscopic surgery: the need for guidelines

BMJ 1994; 308 doi: (Published 16 April 1994) Cite this as: BMJ 1994;308:1023
  1. C M S Royston,
  2. M R J Lansdown,
  3. W A Brough
  1. Hull Royal Infirmary, Hull HU3 2JZ St James's University Hospital, Leeds Stepping Hill Hospital Stockport
  1. Correspondence to: Mr Royston.

    There is a risk that minimally invasive surgery will fall into disrepute unless adequate steps are taken to reassure the public. Some form of accreditation after a recognised training scheme would go a long way towards allaying these fears. The cost of training surgeons must be addressed. Adequate training will probably pay dividends in reduced litigation. The royal colleges should be responsible for maintaining standards of teaching on recognised courses, setting criteria for accreditation, and supervising a national audit of all laparoscopic procedures.

    The explosion of interest in minimally invasive surgery among surgeons and gynaecologists represents the most dramatic change in surgery since the introduction of anaesthesia. Laparoscopic cholecystectomy was introduced into the United Kingdom in 1989 and has rapidly become the treatment of choice for symptomatic gall stones. Studies from the United States, Europe, and the United Kingdom have shown a decreased mortality and shorter inpatient stays with this treatment.*RF 1-3* General morbidity from cholecystectomy has also been considerably reduced, but unfortunately the incidence of common bile duct damage has increased.4

    The introduction of laparoscopic cholecystectomy into the United Kingdom has been haphazard and uncontrolled, with about a third of surgeons being completely self taught.5 The Royal College of Surgeons of England made a useful early statement in 1990 as to how training should proceed6 but has done nothing since to enforce this; nor has it the facility whereby this training can be achieved. In North America, the Society of American Gastrointestinal Surgeons made a statement suggesting guidelines for “credentialling surgeons” in the performance of laparoscopic procedures,7 and Dent has outlined a training programme that is used in Pennsylvania.8 In the United Kingdom, lack of equipment as well as lack of training initially hindered the introduction of minimally invasive techniques. There is now no …

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