It’s been more than 20 years ince the first laparoscopic surgery was performed.
Techniques behind minimally
invasive surgery (MIS) have
evolved, and its possibilities
are still being explored. More
work can be done to continue
educating surgeons about the
benefits of MIS, expanding what
it can be used for and putting an
emphasis on enhanced recovery. That’s what Dr. L. Michael
Brunt, president of the Society of American Gastrointestinal
and Endoscopic Surgeons (SAGES), and Dr. Brian Dunkin,
SAGES president-elect, said.
What all of those things come down to is training and education, but that’s also an issue, Brunt explained. “I think the
economic realities of today are such that surgeons are being
asked to do more and more in their practices,” he elaborated.
“It’s hard to get away from your practice and commit to
that ongoing training and education. I think that’s one barrier that’s out there that hasn’t been addressed.” Healthcare
organizations could create positive incentives for surgeons to
receive ongoing training, but that most likely won’t happen,
he said, posing it as a possible solution.
Dunkin said another reason
surgeons don’t receive MIS train-
ing is they don’t get paid more
for performing minimally invasive
procedures, and, many times, they
get paid less per surgery. That’s
a systematic problem, he noted.
“Hospitals are also not currently
incentivized to offer MIS tech-
niques since they are paid to fill
beds, not get patients out of the
hospital quicker,” he explained.
“As U.S. healthcare moves away
from fee for service and toward pay for performance, or
value-based reimbursement, MIS will be better recognized as
critically important in maximizing value for patients requiring
If a surgeon does choose to learn the less invasive tech-
niques, Dunkin said there’s been a few changes in the past
year or so to make the training more structured and compre-
hensive. For instance, the American Board of Surgery (ABS)
determined general surgeons in the United States needed
improved training in flexible gastrointestinal endoscopy and
created a formal curriculum, led by SAGES. This is the first
year the certification has been available, and
it includes sub-certifications such as: funda-
mentals of laparoscopic surgery, fundamentals
of endoscopic surgery and fundamental use
of surgical energy. “This meets one of the
biggest gaps in knowledge, I think, in all of
surgery,” Brunt stated.
Another change was, starting in 2013,
surgical residents were told all chief residents in general surgery who want to be ABS
certified would have to have graduated from
the program. This will be effective in 2018.
“This program will change the surgical work-force, making it more competent in flexible
endoscopy and able to offer these services to
patients,” Dunkin predicted.
Dunkin also pointed to telementring as
an option to help train, since performing a
Dr. Brian Dunkin,
Dr. L. Michael Brunt,
SAGES leaders share why education is key for surgeons and patients alike.
by Rebecca Rudolph, editor
Minimally invasive surgeries have been proven to mean less scaring, a quicker
recovery time and other benefits for patients. Photo contributed by SAGES.