SAGES has been at the forefront of best practices in laparoscopic and endoscopic surgery by researching, developing and disseminating the guidelines and training for standards of practice in surgical procedures. Guidelines are developed under the auspices of the organization and its various committees, and approved by the Board of Governors. Each clinical practice guideline has been systematically researched, reviewed and revised by the Guidelines Committee and also evaluated by an appropriate multidisciplinary team. Guidelines are scheduled for periodic review to allow incorporation of pertinent new developments in medical research knowledge, and practice.
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The SAGES Continuing Education Committee has developed an effective means for identifying gaps in learners’ knowledge, competency, and performance through direct survey of Annual Meeting attendees. These reports have revealed consistent patterns related to perceived gaps and topics of interest among Annual Meeting attendees, including learners’ consistent identification of four common topics as foci of interest: bariatric surgery, colon and rectal diseases, surgery of the foregut, and hernia repair
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) would like to add its voice to the other surgical organizations who support the concept of continuous certification for surgeons and strongly argues against movements to initiate legislation prohibiting MOC/CC.
The following clinical spotlight review regarding the laparoscopic treatment of common bile duct stones is intended for physicians who manage and treat gallbladder disease and choledocholithiasis. It is meant to critically review these techniques and the available evidence regarding their safety and efficacy. Provided recommendations for clinical practice are linked to the level of available evidence, and where evidence is lacking expert opinion is offered.
Contemporary colorectal surgery is often associated with long length of stay (8 days for open surgery and 5 days for laparoscopic surgery), high cost, and rates of surgical site infection approaching 20%. During the hospital stay for elective colorectal surgery, the incidence of perioperative nausea and vomiting (PONV) may be as high as 80% in patients with certain risk factors. After discharge from colorectal surgery, readmission rates have been noted as high as 35.4%. An enhanced recovery protocol (ERP) is a set of standardized perioperative procedures and practices that is applied to all patients undergoing a given elective surgery. In general, these protocols are not intended for emergent cases, but components of them certainly could apply to the emergent/urgent patient. Also known as fast-track protocols or enhanced recovery after surgery (ERAS) protocols, the content of these specific protocols may vary significantly, but all are designed as a means to improve patient outcomes. Outcomes of interest to patients and providers include freedom from nausea, freedom from pain at rest, early return of bowel function, improved wound healing, and early hospital discharge. Although numerous perioperative protocols currently exist, this clinical practice guideline will evaluate the strength of evidence in support of measures to improve patient recovery after elective colon and rectal resections.
The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recognizes that the discipline of surgery is dynamic and continues to evolve. Modifications of standard surgical procedures and completely new procedures are usually introduced gradually into clinical practice, a process that may require special training or privileges. Additional training will often be required to integrate techniques or procedures that are new to the individual surgeon. The same is also true for procedures that represent a substantial change in existing methods or practices or that require familiarity with new technology. The purpose of this document is to provide guidelines for course directors who plan to design educational activities for continuing professional development (CPD) of practicing surgeons. Additionally, it provides guidance regarding requirements for SAGES endorsement of such courses.
Transanal minimally invasive surgery (TAMIS) is a technique that was originally devised as a hybrid between Transanal Endoscopic Microsurgery (TEM) and single-site laparoscopy for resection of rectal lesions. It was developed out of the need for a practical alternative to TEM that was both affordable and technically feasible without specialized equipment.
This document provides specific recommendations and guidelines to assist physicians in the diagnostic work-up and treatment of surgical problems in pregnant patients, focusing on the use of laparoscopy. Surgical interventions during pregnancy should minimize fetal risk without comprising the safety of the mother.
The following clinical spotlight review regarding the endoluminal treatment of gastroesophageal reflux disease is intended for physicians who manage and treat GERD. It is meant to critically review these techniques and the available evidence supporting their safety and efficacy. Based on the level of evidence, recommendations may or may not be given for their use in clinical practice.
Since the publication of the SAGES guidelines for venous thromboembolism (VTE) prophylaxis during laparoscopic surgery in 2007 (1), the American College of Chest Physicians (ACCP) has published their comprehensive guidelines that address VTE prophylaxis for non-orthopedic surgery patients (2). After careful review, the SAGES guidelines committee has approved the endorsement of the ACCP guidelines rather than update our previous VTE guidelines.
This clinical spotlight review regarding the intraoperative cholangiogram is intended for physicians who manage and treat gallbladder/biliary pathology and perform laparoscopic cholecystectomy. It is meant to critically review the technique of intraoperative cholangiography, alternatives for intraoperative biliary imaging, and the available evidence supporting their safety and efficacy
These guidelines are intended to assist and provide practical guidance to hospital, ambulatory facility or other credentialing committees in their task of granting privileges for flexible gastrointestinal endoscopy. Privileging in flexible gastrointestinal endoscopy should be based on demonstration of competency in these techniques.
The goals of ventral hernia repair are relief of patient symptoms and/or cure of the hernia with minimization of recurrence rates. While laparoscopic ventral hernia repair (LVHR) has gained popularity in recent years, there is still significant controversy about the optimal approach to ventral hernia repair. This document has been written to assist surgeons utilizing a laparoscopic approach to ventral hernia repair in terms of patient selection, operative technique, and postoperative care. It is not intended to debate the merits of prosthetic use or specific types of prosthetics.
The field of bariatric surgery continues to grow, attracting surgeons with expertise in laparoscopic, gastrointestinal, and bariatric surgery. With the implicit goal of ensuring that surgeons have met minimum criteria to safely perform bariatric surgery, 3 national surgery associations — American Society for Metabolic and Bariatric Surgery (ASMBS), American College of Surgeons (ACS), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) — independently created credentialing guidelines to guide hospitals and institutions in the credentialing process for bariatric surgery. The guidelines were thoughtfully written to assist local credentialing committees in the evaluation of an applicant’s qualifications and were not developed to become a standard of care.
Ethical considerations relevant to the implementation of new surgical technologies and techniques include the following: (1) How is the safety of a new technology or technique ensured?; (2) What are the timing and process by which a new technology or technique is implemented at a hospital?; (3) How are patients informed before undergoing a new technology or technique?; (4) How are surgeons trained and credentialed in a new technology or technique?; (5) How are the outcomes of a new technology or technique tracked and evaluated?; and (6) How are the responsibilities to individual patients and society at large balanced? The following discussion is presented with the intent of encouraging thought and dialogue about ethical considerations relevant to the implementation of new technologies and new techniques in surgery.
These guidelines for the surgical introduction of new technologies and techniques are systematically developed statements designed to assist surgeons when making decisions about the appropriate adoption of modified or new devices and procedures in their practice.
The use of continuous ambulatory peritoneal dialysis (CAPD) as a primary mode of renal replacement therapy has been increasing around the world. The surgeon’s role in caring for these patients is to provide access to the peritoneal cavity via a peritoneal dialysis (PD) catheter and to diagnose and treat catheter complications. Since the early 1990s laparoscopy has been applied by many adult and pediatric surgeons for insertion of PD catheters as well as for salvage of malfunctioning catheters. This document is an evidence based guideline based on a review of current literature and the opinions of experts in the field. It provides specific recommendations to assist surgeons who take care of adult and pediatric peritoneal dialysis patients.
The guidelines for the management of hiatal hernia are a series of systematically developed statements to assist physicians’ and patients’ decisions about the appropriate use of laparoscopic surgery for hiatal hernia. The statements included in this guideline are the product of a systematic review of published literature on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted and expert opinion sought where the evidence is lacking.
The guidelines for the minimally invasive surgical treatment of adrenal pathology are a series of systematically developed statements to educate and guide the surgeon (and patient) in the appropriate use of minimally invasive techniques for the treatment of adrenal disease. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used in specific clinical circumstances. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth.
The following recommendations regarding the safe performance of laparoscopic resection for curable colon and rectal cancer are intended for surgeons experienced in both minimally invasive surgery and the surgical treatment of patients with colon and rectal cancer. This document will not address the endoscopic screening or surveillance for colorectal cancer. SAGES and the ASCRS have previously published a joint statement regarding the credentialing process. SAGES also has published guidelines that specifically address credentialing surgeons for laparoscopic procedures in general.
The guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used in treating this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth.
The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recommends the following guidelines for privileging qualified surgeons in the performance of ultrasound (transabominal, laparoscopic, endoscopic, thoracoscopic surgery, and endovascular). The basic premise is that the surgeon(s) must have the judgment and training to perform ultrasonography safely and accurately interpret the findings.
SAGES (The Society of American Gastrointestinal and Endoscopic Surgeons) will provide quality education in the cognitive and technical aspects of minimally invasive gastrointestinal and endoscopic surgery to fulfill the continuing medical education and maintenance-of-certification needs of its members.
The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) endorses the following concepts for training in laparoscopic surgery.
Training in diagnostic and therapeutic ERCP should only be sought by individuals with interest and training in the treatment of hepatopancreaticobiliary disease. Surgeons seeking training in ERCP should anticipate performing adequate numbers of procedures to maintain proficiency, and remain committed to advancing their skills in this continually evolving procedure.
The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recommends the following guidelines for privileging qualified surgeons in the performance of surgical procedures utilizing laparoscopy and/or thoracoscopy alone, or in a hybrid fashion with hand or robotic assistance. The basic premise is that the surgeon(s) must have the judgment and training to safely complete the procedure as intended, as well as have the capability of immediately proceeding to a traditional open procedure when circumstances so indicate. As a basic premise, surgical privileging should be based on training, surgical board certification, and ongoing practice experience
These diagnostic laparoscopy guidelines are a series of systematically developed statements to assist surgeons’ (and patients’) decisions about the appropriate use of diagnostic laparoscopy (DL) in specific clinical circumstances. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are described and expert opinion sought where the evidence is lacking. This is an update of previous guidelines on this topic (SAGES publication #0012; last revision 2002) as new information has accumulated.
Congress and others have called into question the propriety of professional medical associations (PMAs) and industry relationships. These relationships are critical to the continued development of new and better surgical devices and procedures for patients. Moreover, PMAs should work with industry in defined ways to educate physicians about new procedures and devices. Clear guidelines are needed to help structure these relationships.
The guidelines for the surgical treatment of gastroesophageal reflux disease (GERD) are a series of systematically developed statements to assist physicians and patient decisions about the appropriate use of laparoscopic surgery for GERD. The statements included in this guideline are the product of a systematic review of published literature on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted and expert opinion sought where the evidence is lacking.
Laparoscopic cholecystectomy has become the standard of care for patients requiring the removal of the gallbladder. In 1992, an NIH consensus development conference concluded "laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones, laparoscopic cholecystectomy appears to have become the procedure of choice for many of these patients"
SAGES fully endorses the evolution of new treatments for gastrointestinal conditions that provide patients a faster recovery from their procedures while at the same time providing high quality outcomes. This document addresses the rationale for endolumenal therapies, considers the provider qualifications needed to perform these procedures, and discusses the issues of reimbursement and future directions.
The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recommends the following guidelines for privileging qualified surgeons in the performance of laparoscopic bariatric surgical procedures. The basic premise is that the surgeon must have the judgment and training to safely complete the procedure as intended, as well as have the capability of immediately proceeding to a traditional open procedure when circumstances so indicate. Moreover this assumes the surgeon practices as part of a bariatric team to provide adequate preoperative care and long term follow up.
The following outline has been compiled by the SAGES Resident Education Committee and is meant to serve as a guideline for objectives to be met for a thorough resident education in the areas of flexible gastrointestinal endoscopy and in laparoscopic and thoracoscopic surgery.
Laparoscopic techniques have become an integral part of the operative management in virtually every realm of general surgery. The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) is dedicated to the advancement of training in minimal access surgery to ensure the safe performance of such operations. The purpose of this document is to foster the integration of advanced laparoscopic surgical training into the curriculum of the general surgery residency.
I. Preamble The laparoscopic approach to appendectomy has gained wide acceptance over the last 15 years as a means of improved diagnostic accuracy and wound complication rate over the open procedure. Despite a breadth of data and widespread adoption of the technique, there continues to be controversy regarding the advantages of this approach in hastening […]
The use of ultrasound in the operating room by surgeons is increasing, and the indications and use of ultrasound by laparoscopists and endoscopists are evolving. These guidelines are intended to provide current recommendations in the use and benefits of laparoscopic ultrasound (LUS) for the surgeon. They are not intended to show the only uses and applications but rather ones where data are available to make a recommendation. Recommendations are based on the current medical evidence and are graded according to that evidence.
CLINICAL PRIVILEGES Authorization by a health care organization allowing a health care practitioner to provide a defined class of patient care services. COLLABORATIVE PRACTICE A medical or surgical procedure performed by two or more competent health care practitioners within the same or different specialties. These practitioners will have expertise in various portions of the procedure, […]
A number of factors including reimbursement have produced a demand for endoscopy to be performed in an office based setting as compared to a hospital or ambulatory center setting. Many gastrointestinal endoscopy procedures can be performed safely in the office setting. To ensure that patients having endoscopy in an office setting have the appropriate level of safety and quality, standards of care need to be set and met. These standards should be similar if not the same as the standards set for an institutional setting.
As surgery is an integral part of health care and a major public health concern, and while the volume of surgery is rapidly growing worldwide, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) welcomes the new "Safe Surgery Saves Lives" initiative of the World Health Organization's (WHO) World Alliance for Patient Safety, which for the first time, addresses patient safety in surgical care as a matter of global importance.
Approximately one-third of US adults are obese. The health consequences of severe obesity have been well described. Current evidence suggests surgical therapies offer the best hope for substantial and sustainable weight loss in the extremely obese, with resultant mortality reduction. These truths, coupled with improved minimally invasive bariatric procedures, have driven a fourfold increase in the population-based rate of bariatric surgery over recent years.
This SAGES/ASGE co-endorsed guideline is only available as a PDF SAGES/ASGE Role of Endoscopy in the Bariatric Surgery Patient
This SAGES/ASGE Co-Endorsed Guideline is only available as a PDF SAGES/ASGE Infection Control During GI Endoscopy
This guideline is only available as a PDF file. Sedation and Anesthesia in GI Endoscopy
Robotic surgical devices have developed beyond the investigational stage and are now routinely used in minimally invasive general surgery, pediatric surgery, gynecology, urology, cardiothoracic surgery and otorhinolaryngology. Robotic devices continue to evolve and – as they become less expensive and more widely disseminated – will likely become more frequently utilized in surgical procedures. The leadership of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Minimally Invasive Robotic Association (MIRA) felt that guidelines for the usage of robots in surgery were lacking, and that the surgical community would benefit from a consensus statement on robotic surgery including guidelines for training and credentialing.
Credentialing for the performance of both diagnostic and therapeutic esophagogastroduodenoscopy (EGD) and colonoscopy should be based on prior demonstration of proficiency in the performance of these techniques. Privileges should be granted for each major category of endoscopy separately; i.e., upper endoscopy, enteroscopy, biliopancreatic endoscopy, sigmoidoscopy, colonoscopy, etc. Proficiency in endoscopy should include both diagnostic and therapeutic procedures as there is no role for “diagnostic only” credentialing.
A Focus Group on Laparoscopic Colectomy Education was convened and has developed a guideline for educating trained surgeons in the use of laparoscopic colectomy for colorectal disease. This guideline has been developed to address the increased interest in laparoscopic colectomy for cancer. The group has made recommendations regarding the content, faculty, and training model for hands on courses in laparoscopic colorectal surgery.
Laparoscopic colectomy for curable cancer results in equivalent cancer related survival to open colectomy when performed by experienced surgeons.