Learning Curve of Laparoscopic Surgery
Since laparoscopy was introduce in urological surgical practice. There has been an advance increase in the number of its possible applications in our field of work. Including both complex oncological excision surgeries and careful constructive techniques. This situation is bringing new and promising winds of change to our specialty but these procedures require prior training. So that it can be carry out correctly to acquire sufficient manual skill. For that it does not cause any avoidable damage to the patients. Who are going to be subject to these techniques. The technique many of them have learn Ethicon Laparoscopic Trainer.
This model of action which is actually inherent to all surgical practice. Acquire special ethical connotations when referring to laparoscopic surgery. First, for laparoscopically operable pathologies, another surgical alternative is already available: conventional open surgery. Therefore, the indication for laparoscopic surgery will only make sense for each specific patient. If it is expect to achieve a greater benefits (less potential morbidity) also in the learning stage. With this type of surgery compare to open surgery. The existence of a “steep” learning curve, assume as such, by almost all surgeons who are experts in laparoscopy.
Public Health Care
Another consideration, the patient’s right to truthful information. Respecting his freedom to choose what he considers to be “the best option”. Since we are talking about different surgical approach modes for the same indications. Finally in public health care, competitiveness in the cost-benefit equation of these new techniques must also be consider. Both economically and socially to justify their introduction as a common practice. Without giving rise to delays from the rest of the patients.
Although this global approach to the situation may seem too demanding. It is by no means ideal when consider in detail, as outlin below, and its acceptance should set the minimum standard for the establishment of laparoscopic surgery compatible with the criteria. of good clinical practice. This will avoid unnecessary traumatic situations, falsely self-justify by the forceindividual learning curve.
Specifically learning in laparoscopy can be carry out using various modalities. Such as the pelvitrainer, performing laparoscopy with experimental animals or cadavers, in specially equip centers. Using virtual reality simulators. Whatever the chosen modality, a high cost must be assume both in terms of dedication time and material resources. Possibly the best option, not always easy to plan. Co-pilot with an already experience laparoscopic surgeon. Obviously, the need for specific training and duly internalize before starting a surgery of this type in humans. Makes a period of basic training with experimental animals very convenient. It seems to be expect that the more fluency or skill has been acquire through experimental surgery. The less time it takes to transfer said skill to surgical rehearsal in humans with the following technical support of surgeons experience in laparoscopy.
Which is the ethical principle that forces not only not to do evil, but to do good. That is one would be able to perform laparoscopic surgery only if it is believe that it is capable of providing a benefit. With these techniques to each specific patient. If this is not yet the situation that the training phase must still be maintain.
Moving on to the next consideration about the learning curve. As already mention this cannot be a justifying argument for a higher morbidity. In the first patients who are going to undergo these techniques in a specific center that decides start your journey in this surgical tour. In fact, the possibility of limiting the laparoscopic time of this surgery. This decision has been define as “program reconversion”. Contrary to those who consider this type of procedure of the surgical act. This action should be adopt as one of the prerequisites require to carry out the learning curve without risks.
Existing Healing Alternatives
In cases in which the risk / benefit equation is doubtful due to its duration. The Healthcare Ethics Committee of each center should be consult, and the existing healing alternatives should be report. In this way, assuming a possible conversion with an increase in surgical time pre-establish as acceptable. Without adding costs or morbidity progressive learning of techniques such as essential can be achieve. Choose to perform the technique laparoscopically to the end, regardless of its duration.
In this regard, it should be remember that the classic rule of medical ethics primum non-damage is largely define by the lexartis and the criteria of indication, non-indication and contraindication. This allows us to understand that the content of this principle must be define at all times. Also reconsidering in each case the risk / potential benefit equation for each patient, according to the development of the surgeon’s skill. Thus, the history of previous surgery or the extension of the process may contribute to a greater difficulty of the technique in the face of the same indication. Making laparoscopic intervention inadvisable in these cases.