Vicente Gonzalez-Ruiz, MD, Miguel D Santana, MD, David Valadez-Caballero, MD. Mexico City General Hospital / High Speciality Regional Hospital Zumpango.
Introduction: The economic and ethical considerations about perform procedures on patients during the training program of residents have been widely discussed but it is unquestionable that laparoscopic surgery requires a highly qualified staff and the surgeons in training programs need quality education before apply the knowledge in humans.
Methods: Prospective-observational trail in the tertiary care school Mexico City General Hospital, during 8 years evaluated the training tutorial program for residents of General Surgery which included three phases: Basic practice in inanimate simulator, advanced practice in biological models, Clinical practice performing supervised laparoscopic surgeries.
Results: 355 residents evaluated who completed laboratory practice. Weekly evaluations by an experienced surgeon. The montly percentage improvement was: movement skills 7.9%, Dissection 6.4%, suture 6.4% and mixed skills 4.6%. Advanced level evaluated biological models skills whit time progress: appendisectomy 34%, cholecystectomy 43%, nefrectomy 58% and funduplicature 47%. 3454 laparoscopic cholecystectomies were performed, 1071 performed by residents assisted by expert surgeons. The mean duration of operation was 98.2 minutes compared with the general surgeons who made 90.5. Coversion rate 1.66% vs 1.64%. Bleeding 0.68% vs 0.41%. Bile duct lesión 0.20% vs 0.4%. Mortality 0.43% vs 0.40%.
Conclusions: It is necessary an intense structured training program enabling learning with a high level of assurance with clinical simulation as close as possible to reality. The experimental laboratory practice enables the development of primary skills, reducing operating times and complications. The education in laparoscopic surgery should supervised by experienced surgeons to supplement the training process and reduce the risk to the patient.
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