Page 60 - World Journal of Laparoscopic Surgery

Rehana Jabeen Raja

There are other limitations due to the nature of laparoscopic 9. Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D,
surgery like the lack of 3D vision and of tactile sensations, 31 Buchmann P. Multidimensional analysis of learning curves in
difficult hand eye coordination and long instruments. laparoscopic sigmoid resection: eight year results. Dis colon
Rectum 2003;46(10):1371-8.
ETHICAL DILEMMAS 10. Cushieri A. Whither minimal access surgery: Tribulations and
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Many dilemmas exist and many questions will always be with Expectations Am J Surg 1995;169:9-19.
us—who bears the burden of the learning curve ? Are the 11. Traxer O, Gettmann MT Wapper CA, et al. The impact of
patients aware of the risks ? Many reports validate the intense laparoscopic skills training on the operation performance
impression that a patient operated upon during the learning of urology residents. J Urol 2003;166:1658-61.
curve takes greater risks and incurs more adverse circumstances 12. Hu Jc Gold KF, Pashos CL, Mehtass, Litwin MS. Role of
than the patient operated upon later. The issue of how informed surgeon volume in radical prostactectomy outcomes. J Clin Oncol
the informed consent should be needs to be addressed. Is the 2003;21:401-5.
integrity and conscience of a surgeon measurable? Should the 13. Gibbs VC, Auerbach AD. Learning curves for new procedures.
forces of marketing be curtailed or regulated? Htpp://www.ahrq.gov/clinic/ptsafety/chap19.htm accessed on
24.4.07.
14. Verdaasdonk EGG, Stassen LPS, Elst Mvander, Karsten TM,
THE WAY FORWARD
Dankelman J. Problems with technical equipment during
Laparoscopic surgery is here to stay and success in it is laparoscopic surgery. Surg Endosc 2007;21:275-9.
determined by how quickly and effectively we learn. However 15. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk
certain measures may be taken to lessen some of the adverse AF, Russell IT.Assessment of the learning curve in health
effects of the learning curve and others to help laparoscopic technologies. A systemic review. Int J Technol Assess Health
32
surgeons ease into the specialist. Setting up of minimal Care 2000;16:1095-108.
standards and credentialing is a must. Current guidelines in 16. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk
many countries are vague and general. The evidence for training AF, Russell IT. Statistical assessment of the learning curves of
is well documented. The message for individual surgeons is to health technologies. Health Technol Assess 2001;5:1-79.
identify their deficiencies, and chart a way forward for their 17. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk
personal graph of progress. Evaluation and monitoring in a AF, Russell IT. Lessons from the non clinical literature. Int J
systematic scientific manner will benefit the surgeon with a Technol Assess Health Care 2002;18:1-10.
satisfactory learning curve that will ensure that patient welfare 18. Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD.
is not compromised. Laparoscopic colorectal surgery. Do we get faster ? Surg Endosc
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19. Schlachta CM, Mamazza J, Seshadri PA Cadeddu M, Gregoire
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