There is a risk that minimally invasive surgery will fall into disrepute unless adequate steps are taken to reassure the public. Some form of accreditation after a recognised training scheme would go a long way towards allaying these fears. The cost of training surgeons must be addressed. Adequate training will probably pay dividends in reduced litigation. The royal colleges should be responsible for maintaining standards of teaching on recognised courses, setting criteria for accreditation, and supervising a national audit of all laparoscopic procedures.
PIP: Laparoscopy was introduced to the UK in 1989. Today, about 33% of surgeons performing laparoscopic cholecystectomy were self-taught. No guidelines for laparoscopic procedures exist. Perforation of the bowel during laparoscopy causing peritonitis and death of a London woman resulted in private London hospitals requiring consultant surgeons to have accreditation before performing laparoscopic procedures. Some trust hospitals bar surgeons who have had problems with these procedures from performing any laparoscopy. The Royal College of Surgeons and surgical societies interested in minimally invasive surgery should be responsible for laparoscopic training and accreditation of surgeons. They would need to establish criteria for accreditation and a mechanism of appeal for surgeons who fail accreditation. Such action would allay public anxieties. 3 consultant surgeons have taught courses for laparoscopic cholecystectomy and laparoscopic hernia repair. They have done demonstrations or proctorships at 29 UK hospitals. These surgeons suggest that the ideal training for a laparoscopic procedure includes, in order, a video, a pelvitrainer, hands-on training, and training under an experienced surgeon at his/her hospital (proctorship). It is best if at least 2 surgeons from the same hospital undergo the training simultaneously. After successful completion of training as deemed by the proctor, the trainee should receive accreditation. The surgeons advise that laparoscopic training first be limited to consultant surgeons until there are enough trained surgeons who can train junior surgeons. The UK government has set up 3 minimally invasive centers in London, Leeds, and Scotland, where commercial companies instead of the Royal College of Surgeons will do the training. A comprehensive evaluation should be conducted to determine true incidence of mortality and complications.