The Integration of Minimally Invasive Surgery in Surgical Practice: Results From Two Consecutive Province-wide Practice Surveys of General Surgeons Over a 5-year Period.

Julie Hallet, MD, FRCSC, Olivier Mailloux, MD, Mony Chhiv, MD, FRCSC, Roger C Gregoire, MD, FRCSC, Jean-Pierre Gagne, MD, LLM, FRCSC

Department of Surgery, Centre Hospitalier Universite de Quebec – Hôpital Saint-Francois d’Assise, Quebec Centre for Minimally Invasive Surgery, Quebec, QC, Canada

Introduction: Most surgeons have quickly embraced the practice of minimally invasive surgery (MIS); however, the introduction of advanced procedures appears more complex. The purpose of this study is to assess the evolution of MIS practice in Québec over a 5 years period in order to identify needs or ways for improvement in the modern surgical era.

Methods: We developed and test-piloted a self-administered questionnaire that was sent to Québec general surgeons in 2007 and 2012. It assessed four chosen domains: parameters of surgical practice, stated MIS practice, MIS training as well as barriers and facilitators to MIS practice. We performed univariate analysis to compare responses in 2007 and 2012, and multivariate analysis using logistic regression to assess the variables associated with the practice of advanced MIS.

Results: Response rate was 51.3% (n=251/489; precision 6.2%) in 2007 and 31.3% (n=153/491; precision 7.9%) in 2012. The mean age was 45.1 (±10.6) and 43.7 (±10) years old in 2007 and 2012 respectively. Seventy-one percent were male in both surveys. Over the last 5 years, more surgeons practiced laparoscopic appendectomy (94.0% vs. 82.3%, p=0,003). Open method for pneumoperitoneum creation is the preferred approach and is used more often in 2012 (76.0% vs. 63.5%, p=0.011). More surgeons practiced 3 or more advanced MIS procedure in 2012 (82.3% vs. 64.3%, p<0,001). We observed a significant increase in the practice of most advanced MIS procedures, especially for colectomy for benign (66.0% vs. 84.3; p<0,001) or malignant diseases (43.3% vs. 77.8%; p<0,001) and rectal surgery for malignancy (21.0% vs. 54.6%; p<0.001) from 2007 to 2012. Mutlivariate analysis confirmed this significant change in practice, with the 2007 survey administration associated with a lower proportion of surgeons performing 3 or more advanced MIS procedures (OR 0.13 [0.06-0.29], p<0.001). Finally, the number of respondents stating to have gained their skills during residency significantly increased in 2012 (p=0.028).

Conclusion: We observed that from 2007 to 2012 there was a significant increase in the practice of advanced MIS procedures by general surgeons in Québec. More surgeons have integrated MIS procedures in their practice and this technique now appears well established in the current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development over the last 5 years. Results from this survey could be used as a baseline for studies focusing on ways to further improve the existing MIS practice and examine the need for integrating newer technological advances in the current practice, in relation with evidence-based data in the field.

Session: Poster Presentation

Program Number: P145