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Myriam Curet, MD Associate Professor of Surgery Stanford University Medical Center Director, Minimally Invasive Program At present, laparoscopic surgery is considered one of the primary components of general surgery. A separate certification process for laparoscopic surgery does not exist. Many general surgery residencies cover basic laparoscopy within their residency program, which includes diagnostic laparoscopy, laparoscopic cholecystectomy, and appendectomy. The experience with more advanced cases is variable. Many residents consider doing a fellowship in minimally invasive surgery in order to acquire more experience with advanced cases, such as Nissen fundoplication, myotomy, herniorrhaphy, adrenalectomy, splenectomy, colon resection, liver resection, pancreatic resection, gastric resection, and donor nephrectomy. Residents who are considering laparoscopic bariatric surgery should definitely consider a laparoscopic fellowship, as it is nearly impossible to receive adequate training in laparoscopic bariatric surgery during a general surgery residency. There is significant variation in the types of fellowship programs available. At present, most are only one year in length, although several programs combine a year of research and a year of clinical work. The clinical experience can include: general endoscopy, such as colonoscopy and upper endoscopy; experience in open surgery; or may be focused on purely bariatric surgery. It is important to know what kind of clinical training will meet your goals prior to making a decision about what fellowship you want to attend. Training Requirements and FellowshipsAt present, there are no minimally invasive surgery boards and no specific training requirements beyond residency. Most minimally invasive surgery fellowships require that the individual have completed a general surgery residency program and be board eligible in general surgery. A listing of available fellowships can be accessed through the Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Although there is not presently a match process, it is generally recommended that the application process be started early in the chief year. SAGES recommends that applications be accepted until October 1st and decisions be made by December 1st of the same calendar year for fellowships to begin the following July. Most fellowships do require an interview. Occasionally these can be done during the American College of Surgeons Clinical Congress that meets in October. Residents who are considering an academic career in minimally invasive surgery should definitely pursue a fellowship. However, many residents who are going into private practice also desire further experience in advanced laparoscopic cases in order to bring this expertise to their new practice. Research Opportunities and Grant Funding Medical StudentsThe best way for medical students to find research opportunities is through faculty at their school. Identify a faculty member within an institution with an interest in advanced minimally invasive surgery and explore possibilities. You may be able to participate in their research and develop a project of your own. Your sponsor/mentor should be able to help you find funding as needed. Surgery ResidentsThe best way for surgery residents to find research opportunities is locally. Your mentor, advisor, program director or faculty can help. In addition, SAGES has grants available for research. For other possibilities, see below under "Faculty". FacultyThere are many funding opportunities for research in all aspects of minimally invasive surgery. SAGES has grant funding available through their websites for resident salaries and for study support. In addition, many other grants that are available to general surgeons are open to researchers who have projects in minimally invasive surgery. For example, the Association of Women Surgeons in connection with Ethicon Endo-Surgery, Inc. has a grant available which can be applied to research in bariatric surgery. The Association for Surgical Education has research money available for educational grants for research in training of technical skills. The American College of Surgeons is another source for possible funding as is the Society of University Surgeons. State and local public health departments and local organizations may also support research. Membership SAGESSAGES was founded in 1981 primarily as an organization for surgeons who performed flexible endoscopy, but now, a major focus is minimally invasive surgery. During and after the 1989-1991 explosion of minimal access surgery, the Society undertook a leadership role in setting standards for emerging techniques in general surgery. SAGES now has more than 4200 members from every state and over 30 foreign countries. Membership includes academic surgeons, clinical practitioners, residents, and fellows. The society's focus includes education for practicing and in-training surgeons, guidelines for training, granting of privileges, new technology, development of standards of practice, endoscopic and laparoscopic research, integration of endoscopic and laparoscopy into residency programs. SAGES presents an annual scientific session and postgraduate course, various hands-on courses, and a full range of courses and educational programs for residents. They also have candidate membership status for residents. Society of Laparoendoscopic Surgeons (SLS)The SLS is an educational, non-profit organization established to help ensure the highest standards for the practice of laparoscopic, endoscopic and minimally invasive surgery. A fundamental goal of SLS is to make certain that its members have access to the newest ideas and approaches as rapidly as possible. SLS makes information available through publications, videos, conferences, and other electronic media. Society for Surgery of the Alimentary Tract (SSAT)SSAT is another organization for surgeons interested in laparoscopic surgery of the alimentary tract. The objectives of the SSAT are to stimulate, foster, and provide surgical leadership in the art and science of patient care, to teach and research the diseases and functions of the alimentary tract, to present a forum for the presentation of such knowledge, and to encourage training opportunities, funding and scientific publications supporting the forgoing activities. SSAT holds their annual meeting during Digestive Disease Week and abstracts are presented in the Journal of Gastrointestinal Surgery. References
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American College of Surgeons
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Association for Surgical Education 5204 Fairmount Avenue, Suite 208 Downers Grove, IL 60515 630-655-0392 630-963-0297(FAX) email: info@womensurgeons.org website: www.womensurgeons.org
4. SAGES
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Society of Laparoendoscopic Surgeons
6. Society for Surgery of the Alimentary
Tract
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Society of University Surgeons
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