A global impact: MUHC-trained surgeons boost practice of minimally invasive surgery around the world
MIS Fellow, Dr. Amy Neville with Dr. Liane Feldman, Director of the Division of General Surgery at the MUHC.
A whole generation of surgeons has now been trained in Minimally Invasive Surgery (MIS, sometimes known as “keyhole surgery”) at the MUHC, and is spreading this impressive skill set around the world. The MIS training program at the MUHC has helped make the institution a leader in this increasingly common form of surgery.
“When we started doing minimally invasive surgery in the early 1990s we didn’t have any formalized training or teaching outside the operating room,” says Dr. Liane Feldman, Director of the Division of General Surgery at the MUHC. “Our apprenticeship model was working well for many surgical skills, but we needed to train people in these new MIS-specific skills such as working in a two-dimensional space under videoscopic guidance, with new instruments, and less tactile sense. We felt this would be best accomplished outside of the operating room (OR).”
A training program was developed to help surgeons learn MIS-related skills. That program has grown and become more sophisticated over the years. Today, much of the preliminary MIS training is done using simulation, either at The Arnold and Blema Steinberg Medical Simulation Centre at McGill University or at the Montreal General Hospital.
“We use a variety of simulations, which allow people learn from their mistakes,” says Dr. Feldman. “We have created or invented our own simulation for more complex procedures.”
One common simulation tool is a simple opaque box. Trainees use the instruments they would use in the operating room to work inside the box, doing basic tasks like tying a knot to simulate suturing. The box can also be used to simulate specific procedures. By inserting a special lining into the box, trainees can “get the feel” of doing surgery on different parts of the body.
MIS training guided by research
“We want to take a rigorous and scientific approach to education,” says Dr. Feldman, “so we also have a research program focused on creating simulations and then validating their use. Residents and trainees are very busy, so we need research to prove the value of the simulations.”
MIS Fellow Dr. Amy Neville, herself a former MUHC surgical resident, is now involved in teaching MIS skills to residents. “Simulations are good for learning basic skills such as suturing, instrument manipulation and, tissue handling,” she explains. “Some simulations are quite basic. Residents work with a task box, learning to transfer little rings back and forth on pegs to get used to using the instruments based on visual input from a camera”.
“MIS specialists can be involved in anything from colon cancer to kidney transplants or hernia repairs, so the training is quite complex,” she explains. “The apprenticeship model is more effective when acquiring advanced skills. As an MIS trainee, I spend most of my time in the OR.”
Hundreds of MUHC-trained surgeons are now working in hospitals across the globe, creating their own training programs and teaching others important MIS skills. “With the training they receive here they can perform MIS as skillfully as open surgery, to the benefit of their patients.” says Dr. Feldman. “That’s something to be very proud of.”