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Journal of Minimally Invasive Surgery 2023; 26(4): 178-179

Published online December 15, 2023

https://doi.org/10.7602/jmis.2023.26.4.178

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

Advancements and challenges in minimally invasive surgery training among general-surgery residents in Thailand

Gyung Mo Son1,2

1Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Korea

Correspondence to : Gyung Mo Son
Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea
E-mail: skm1711@pusan.ac.kr
https://orcid.org/0000-0002-8861-6293

Received: November 24, 2023; Accepted: December 6, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Minimally invasive surgery (MIS) offers several benefits, including reduced pain, faster recovery time, and improved cosmetic outcomes [1]; hence, it is essential for general-surgery residents to receive training in both open and MIS techniques. This study examines the trends in minimally invasive and open procedures performed by general surgery residents in Thailand [2]. Mastering MIS involves a steep learning curve compared to open surgery, making it a challenging task to train residents in MIS. For residents beginning to learn laparoscopic surgery, the basic technical difficulties of laparoscopic surgery may act as a barrier. The first challenge is manipulating the laparoscopic instruments that move in the opposite direction relative to the abdominal wall; second, there may be difficulty in understanding three-dimensional depth while viewing through a two-dimensional monitor; third, there may be discrepancies between the visual field on the monitor and the actual surgical space. All these factors result in a steeper learning curve for novice doctors starting out with laparoscopic surgery [3].

For these reasons, a sophisticated training program is necessary for effectively teaching laparoscopic surgery while ensuring patient safety. Initially, it is important that the surgical residents become familiar with the laparoscopic monitor and instrument manipulation using a laparoscopic training box, followed by practicing with actual organ resection inside the abdomen in animal models. Once accustomed to laparoscopic surgery, it is essential that they learn camera operation and auxiliary traction by assisting with live surgeries. Upon completing basic training during their residency, they can attempt laparoscopic surgeries as lead surgeons. Appendectomy, cholecystectomy, and inguinal hernia repair are known to be appropriate procedures for residents performing their first laparoscopic surgeries [4].

This study [2] shows that over the past decade, the number of laparoscopic surgeries performed by residents in Thailand has increased by about 57%. The procedures with the most significant increases are cholecystectomy and inguinal hernia repair. A unique aspect of the residents’ experiences is that the frequency of laparoscopic appendectomy in Thailand was not high and did not vary much over time. This may be attributed to the limited application of expensive laparoscopic equipment during the growth phase of its introduction and standardization. Furthermore, differences in the insurance policies applicable to each type of surgery according to the national healthcare insurance system might result in variations based on economic costs and medical effectiveness [5]. Such medical environments and differences in the national healthcare systems lead to variations in the laparoscopic surgical experiences of residents in the United States and Thailand.

MIS, such as endoscopic, laparoscopic, or robotic surgery, represents a significant advancement in modern surgical medicine. Recently, the use of fluorescent imaging in fluorescence-guided surgery has become feasible for MIS, greatly assisting novice surgeons in performing surgeries more safely [68]. However, it is also true that MIS is a high-cost procedure requiring expensive laparoscopic equipment and consumables. Therefore, as a stronger national economy supports the rising medical costs, laparoscopic surgery is likely to expand rapidly, and various discussions should be conducted on educating surgical residents in MIS effectively and safely. This work can therefore be considered as an excellent reflection of the transitional changes in MIS in Thailand [2].

Conflict of interest

The author has no conflicts of interest to declare.

Funding/support

None.

  1. Kim JG, Heo YJ, Son GM, Lee YS, Lee IK, Suh YJ, et al. Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer. ANZ J Surg 2009;79:817-823.
    Pubmed CrossRef
  2. Eurboonyanun C, Aphinives P, Wittayapairoch J, Eurboonyanun K, Srisuk T, Punchai S, et al. Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand. J Minim Invasive Surg 2023;26:121-127.
    Pubmed KoreaMed CrossRef
  3. Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, et al. Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech A 2010;20:609-617.
    Pubmed CrossRef
  4. Charondo LB, Brian R, Syed S, Chern H, Lager J, Alseidi A, et al. Confronting new challenges: faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape. Surg Open Sci 2023;16:1-7.
    Pubmed KoreaMed CrossRef
  5. van der Veen A, van der Meulen MP, Seesing MF, Brenkman HJ, Haverkamp L, Luyer MD, et al. Cost-effectiveness of laparoscopic vs open gastrectomy for gastric cancer: an economic evaluation alongside a randomized clinical trial. JAMA Surg 2023;158:120-128.
    Pubmed CrossRef
  6. Kim D, Son GM, Kwon MS, Baek S, Park BS, Kim H. Educational benefits of intraoperative indocyanine green angiography for surgical beginners during laparoscopic colorectal surgery. J Minim Invasive Surg 2018;21:25-30.
    CrossRef
  7. Son GM, Ahn HM, Lee IY, Lee SM, Park SH, Baek KR. Clinical effect and standardization of indocyanine green angiography in the laparoscopic colorectal surgery. J Minim Invasive Surg 2021;24:113-122.
    Pubmed KoreaMed CrossRef
  8. Son GM, Ahn HM, Lee IY, Ha GW. Multifunctional indocyanine green applications for fluorescence-guided laparoscopic colorectal surgery. Ann Coloproctol 2021;37:133-140.
    Pubmed KoreaMed CrossRef

Article

Editorial

Journal of Minimally Invasive Surgery 2023; 26(4): 178-179

Published online December 15, 2023 https://doi.org/10.7602/jmis.2023.26.4.178

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

Advancements and challenges in minimally invasive surgery training among general-surgery residents in Thailand

Gyung Mo Son1,2

1Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Korea

Correspondence to:Gyung Mo Son
Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea
E-mail: skm1711@pusan.ac.kr
https://orcid.org/0000-0002-8861-6293

Received: November 24, 2023; Accepted: December 6, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

Minimally invasive surgery (MIS) offers several benefits, including reduced pain, faster recovery time, and improved cosmetic outcomes [1]; hence, it is essential for general-surgery residents to receive training in both open and MIS techniques. This study examines the trends in minimally invasive and open procedures performed by general surgery residents in Thailand [2]. Mastering MIS involves a steep learning curve compared to open surgery, making it a challenging task to train residents in MIS. For residents beginning to learn laparoscopic surgery, the basic technical difficulties of laparoscopic surgery may act as a barrier. The first challenge is manipulating the laparoscopic instruments that move in the opposite direction relative to the abdominal wall; second, there may be difficulty in understanding three-dimensional depth while viewing through a two-dimensional monitor; third, there may be discrepancies between the visual field on the monitor and the actual surgical space. All these factors result in a steeper learning curve for novice doctors starting out with laparoscopic surgery [3].

For these reasons, a sophisticated training program is necessary for effectively teaching laparoscopic surgery while ensuring patient safety. Initially, it is important that the surgical residents become familiar with the laparoscopic monitor and instrument manipulation using a laparoscopic training box, followed by practicing with actual organ resection inside the abdomen in animal models. Once accustomed to laparoscopic surgery, it is essential that they learn camera operation and auxiliary traction by assisting with live surgeries. Upon completing basic training during their residency, they can attempt laparoscopic surgeries as lead surgeons. Appendectomy, cholecystectomy, and inguinal hernia repair are known to be appropriate procedures for residents performing their first laparoscopic surgeries [4].

This study [2] shows that over the past decade, the number of laparoscopic surgeries performed by residents in Thailand has increased by about 57%. The procedures with the most significant increases are cholecystectomy and inguinal hernia repair. A unique aspect of the residents’ experiences is that the frequency of laparoscopic appendectomy in Thailand was not high and did not vary much over time. This may be attributed to the limited application of expensive laparoscopic equipment during the growth phase of its introduction and standardization. Furthermore, differences in the insurance policies applicable to each type of surgery according to the national healthcare insurance system might result in variations based on economic costs and medical effectiveness [5]. Such medical environments and differences in the national healthcare systems lead to variations in the laparoscopic surgical experiences of residents in the United States and Thailand.

MIS, such as endoscopic, laparoscopic, or robotic surgery, represents a significant advancement in modern surgical medicine. Recently, the use of fluorescent imaging in fluorescence-guided surgery has become feasible for MIS, greatly assisting novice surgeons in performing surgeries more safely [68]. However, it is also true that MIS is a high-cost procedure requiring expensive laparoscopic equipment and consumables. Therefore, as a stronger national economy supports the rising medical costs, laparoscopic surgery is likely to expand rapidly, and various discussions should be conducted on educating surgical residents in MIS effectively and safely. This work can therefore be considered as an excellent reflection of the transitional changes in MIS in Thailand [2].

Notes

Conflict of interest

The author has no conflicts of interest to declare.

Funding/support

None.

References

  1. Kim JG, Heo YJ, Son GM, Lee YS, Lee IK, Suh YJ, et al. Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer. ANZ J Surg 2009;79:817-823.
    Pubmed CrossRef
  2. Eurboonyanun C, Aphinives P, Wittayapairoch J, Eurboonyanun K, Srisuk T, Punchai S, et al. Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand. J Minim Invasive Surg 2023;26:121-127.
    Pubmed KoreaMed CrossRef
  3. Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, et al. Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech A 2010;20:609-617.
    Pubmed CrossRef
  4. Charondo LB, Brian R, Syed S, Chern H, Lager J, Alseidi A, et al. Confronting new challenges: faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape. Surg Open Sci 2023;16:1-7.
    Pubmed KoreaMed CrossRef
  5. van der Veen A, van der Meulen MP, Seesing MF, Brenkman HJ, Haverkamp L, Luyer MD, et al. Cost-effectiveness of laparoscopic vs open gastrectomy for gastric cancer: an economic evaluation alongside a randomized clinical trial. JAMA Surg 2023;158:120-128.
    Pubmed CrossRef
  6. Kim D, Son GM, Kwon MS, Baek S, Park BS, Kim H. Educational benefits of intraoperative indocyanine green angiography for surgical beginners during laparoscopic colorectal surgery. J Minim Invasive Surg 2018;21:25-30.
    CrossRef
  7. Son GM, Ahn HM, Lee IY, Lee SM, Park SH, Baek KR. Clinical effect and standardization of indocyanine green angiography in the laparoscopic colorectal surgery. J Minim Invasive Surg 2021;24:113-122.
    Pubmed KoreaMed CrossRef
  8. Son GM, Ahn HM, Lee IY, Ha GW. Multifunctional indocyanine green applications for fluorescence-guided laparoscopic colorectal surgery. Ann Coloproctol 2021;37:133-140.
    Pubmed KoreaMed CrossRef

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Journal of Minimally Invasive Surgery

pISSN 2234-778X
eISSN 2234-5248