Advancements and challenges in minimally invasive surgery training among general-surgery residents in Thailand

Minimally invasive surgery (MIS) offers several benefits, including reduced pain, faster recovery time, and improved cosmetic outcomes [1]; hence, it is essential for general-surgery residents to receive training in both open and MIS techniques. This study examines the trends in minimally invasive and open procedures performed by general surgery residents in Thailand [2]. Mastering MIS involves a steep learning curve compared to open surgery, making it a challenging task to train residents in MIS. For residents beginning to learn laparoscopic surgery, the basic technical difficulties of laparoscopic surgery may act as a barrier. The first challenge is manipulating the laparoscopic instruments that move in the opposite direction relative to the abdominal wall; second, there may be difficulty in understanding three-dimensional depth while viewing through a two-dimensional monitor; third, there may be discrepancies between the visual field on the monitor and the actual surgical space. All these factors result in a steeper learning curve for novice doctors starting out with laparoscopic surgery [3].

For these reasons, a sophisticated training program is necessary for effectively teaching laparoscopic surgery while ensuring patient safety. Initially, it is important that the surgical residents become familiar with the laparoscopic monitor and instrument manipulation using a laparoscopic training box, followed by practicing with actual organ resection inside the abdomen in animal models. Once accustomed to laparoscopic surgery, it is essential that they learn camera operation and auxiliary traction by assisting with live surgeries. Upon completing basic training during their residency, they can attempt laparoscopic surgeries as lead surgeons. Appendectomy, cholecystectomy, and inguinal hernia repair are known to be appropriate procedures for residents performing their first laparoscopic surgeries [4].

This study [2] shows that over the past decade, the number of laparoscopic surgeries performed by residents in Thailand has increased by about 57%. The procedures with the most significant increases are cholecystectomy and inguinal hernia repair. A unique aspect of the residents’ experiences is that the frequency of laparoscopic appendectomy in Thailand was not high and did not vary much over time. This may be attributed to the limited application of expensive laparoscopic equipment during the growth phase of its introduction and standardization. Furthermore, differences in the insurance policies applicable to each type of surgery according to the national healthcare insurance system might result in variations based on economic costs and medical effectiveness [5]. Such medical environments and differences in the national healthcare systems lead to variations in the laparoscopic surgical experiences of residents in the United States and Thailand.

MIS, such as endoscopic, laparoscopic, or robotic surgery, represents a significant advancement in modern surgical medicine. Recently, the use of fluorescent imaging in fluorescence-guided surgery has become feasible for MIS, greatly assisting novice surgeons in performing surgeries more safely [6–8]. However, it is also true that MIS is a high-cost procedure requiring expensive laparoscopic equipment and consumables. Therefore, as a stronger national economy supports the rising medical costs, laparoscopic surgery is likely to expand rapidly, and various discussions should be conducted on educating surgical residents in MIS effectively and safely. This work can therefore be considered as an excellent reflection of the transitional changes in MIS in Thailand [2].