Recommended
Recommended
More Related Content
Similar to Εκπαίδευση στη Λαπαροσκοπική Χειρουργική Εντέρου
Similar to Εκπαίδευση στη Λαπαροσκοπική Χειρουργική Εντέρου (20)
Recently uploaded
Recently uploaded (18)
Εκπαίδευση στη Λαπαροσκοπική Χειρουργική Εντέρου
- 1. Εκπαίδευση στη Λαπαροσκοπική Χειρουργική Εντέρου. Πώς αρχίζει; Κωνσταντίνος Σ. Μαυραντώνης Διευθυντής Χειρουργικής Κλινικής Νοσοκομείο Ερρίκος Ντυνάν
- 2. Παραδοσιακή εκπαίδευση • Παρατήρηση • Συμμετοχή • Διενέργεια - καθοδήγηση • (ή see one – do one – teach one) – Ενός αιώνα ασφαλής πρακτική
- 3. Παραδοσιακή εκπαίδευση 1. Κατάτμηση της επέμβασης 2. Καθοδήγηση στα χειρουργικά πλάνα • «κόψε εδώ» 3. Επίβλεψη στη παρασκευή πλάνων • Εκπαιδευτής ως βοηθός Εκπαιδευόμενος εκπαιδευτής
- 4. Λαπαροσκοπική Κολεκτομή Βασικές αρχές • Αναγνώριση αναίμακτων πλάνων παρασκευής • Ύψηλή απολίνωση • Επαρκή όρια • Επαρκείς λεμφαδένες • Κατάλληλη εκπαίδευση και επιδεξιότητα
- 5. Δυσκολίες στη Λαπαροσκοπική Εκπαίδευση • Ικανότητα στη διενέργεια της επέμβασης ανοικτά και λαπαροσκοπικά – 2 διαστάσεις – Φαινόμενο του υπομόχλιου – Φαινόμενο του καθρέφτη
- 6. Ο εκπαιδευτής … • Δεν μπορεί: – να «οδηγήσει» την επέμβαση – Χέρια απασχολημένα με εργαλεία / οπτική – να αποτρέψει ατυχήματα – να ελέγξει διαιρούμενους ιστούς • Μπορεί: προφορικές εντολές μόνο
- 7. Λαπαροσκοπικές Κολεκτομές • Εναλλασσόμενα πεδία με σταθερά trocars – Απουσία τριγώνου – Απουσία εργονομίας – Απουσία ορατότητας • 80% κολεκτομών «ανοικτά» (ΗΠΑ)
- 8. Λαπαροσκοπικές Κολεκτομές Ανάγκη για: – Παρασκευή ιστών – Απολίνωση αγγείων – Διενέργεια αναστομώσεων – Πρόβλεψη θέσης trocars • Διαφερετική για κάθε εντόπιση – Αφαίρεση παρασκευάσματος
- 9. Σεμινάρια Εντατική εκμάθηση μικρής διάρκειας
- 10. Σεμινάρια 1. Θεωρητική κατάρτηση i. Τεχνολογία, διάταξη χειρουργείου, ανατομία, χειρισμοί ιστών, ενδείξεις, επιπλοκές ii. Δεξιά & αριστερή κολεκτομή (διαίρεση αγγείων, διαίρεση εντέρου, αναστομώσεις) – με video – live iii. 3D αναστομώσεις με σωλήνες αφρολέξ
- 11. Σεμινάρια 1. Πειραματικό χειρουργείο – Χοίροι • κινητοποίηση ορθού, χρήση κυκλικών συρραπτικών, κολοστομία, σπληνεκτομή, εκτομή λεπτού εντέρου και αναστόμωση – Ανθρώπινα πτώματα • Κολεκτομές, αναγνώριση ουρητήρων, διατήρηση νεύρων, κινητοποίηση καμπής, επίπλουν.
- 12. Πειραματικό χειρουργείο Μείον : 1. Λαπαροσκοπικά κουτιά • Αναστομώσεις 3D 2. Πειραματόζωα (2D) • Διαφορετικές θέσεις trocars • Διαφορετική ανατομία • Αδυναμία ελέγχου του αποτελέσματος 3. Ανθρώπινα πτώματα • Απουσία αιμορραγίας
- 13. Προσομοιωτές • Ρεαλιστικές συνθήκες • Εμπειρία προηγείται της 1ης επέμβασης • Αντικειμενική εκτίμηση απόδοσης • Διαχωρισμός μεταξύ έμπειρων – αρχάριων
- 14. Διδασκαλία 1:1 • Σειρά κολεκτομών, ≅ 2 εβδομάδες – Ασφαλέστερο (παρέμβαση εκπαιδευτή) • Εκπαιδευόμενος «παλεύει» με επίβλεψη • % μετετροπής < 1/3 • Εκπαιδευόμενος δεν εγκαταλείπει • Τηλεδιδασκαλία; • Τηλερομποτική;
- 15. Δεξιό, Αριστερό, Εγκάρσιο, Ορθό – Κοινές αρχές – Σημαντικές διαφορές Ικανότητα σε 1 δε συνεπάγεται ικανότητα σε όλες...
- 16. Μετεκπαίδευση (Fellowship) • 2 χρόνια – Σφαιρική εκπαίδευση • Ενδείξεις • Αντενδείξεις • Τεχνικές • Μτχ παρακολούθηση – Περισσότερες λαπ. κολεκτομές • Προσβασιμότητα;
- 17. Καμπύλη εκμάθησης • Δεξιά & αριστερή κολεκτομή • < 50 για κάθε τύπο επέμβασης – Με μετεκπαίδευση: • 17 για κάθε τύπο επέμβασης • 62% προτιμούν hand assisted
- 18. Καμπύλη εκμάθησης (με μετεκπαίδευση) Πρώτες 50 Επόμενες 50 • Απώλεια αίματος ∀ ∅ • Μετατροπή ∀ ∅ • Χειρουργικός χρόνος ∀ √ • ∀ ∅ Νοσηλεία ∀ ∅ • Όρια εκτομής ∀ ∅ • Λεμφαδένες ∀ ∅ • Επιπλοκές ∀ ∅ • Θνητότητα ∀ ∅
- 19. Σκωληκοειδεκτομή Δε. Κολεκτομή; • 330 σκωληκοειδεκτομές – Χειρ. χρόνος 35’ – Μετατροπή 2% – 0% νοσηρότητα/θνητότητα • 78 δε. Κολεκτομές – Χειρ. χρόνος 115’ – Μετατροπή 1.3% – 9% νοσηρότητα/θνητότητα
- 20. Ικανότητα • Επιπλοκές • % μετατροπής • Χειρουργικός χρόνος (;) • Αποτελέσματα
- 21. Συμπεράσματα 1. Ειδικότητα • Χειρουργική δεινότητα 2. Σεμινάρια • Αποδεκτός 3. Διδασκαλία χειρουργικός χρόνος • Αποδεκτή νοσηρότητα 4. Μετεκπαίδευση
- 22. «Η ικανοποίηση του ιατρού είναι μικρή, η ευγνωμοσύνη των ασθενών σπάνια, και σπανιώτερη ακόμα η υλική ανταμοιβή. Όμως αυτά δεν πρόκειται ποτέ να αποτρέψουν τον εκπαιδευόμενο που νοιώθει το κάλεσμα μέσα του». Theodor Billroth 1829-1894
Editor's Notes
- The paradigm for surgical education and training has remained relatively unchanged for over a hundred years. An apprentice model that includes observation, participation, and the imparting of acquired knowledge to a trainee has been the predominant training method, accepted and adopted due to its ability to guide residents through operations safely with little or no harm to the patient. Long referred to simply as “see one, do one, teach one,”
- The master surgeon is capable of exposing the surgical field in such a manner that the conduct of an operation becomes explicit. The most complex of tasks is often broken down into a series of simple comprehensible steps. The surgical educator is intimately involved in the surgical field and often directs the conduct of the trainee by dissecting tissue planes and allowing the resident to “cut between the lines.” This immediate supervision and direction mitigates against undesired surgical maneuvers. Once trainees have mastered the steps and conduct of a procedure, they then must master the steps required to appropriately expose the surgical field. These steps are best learned by acting as a teaching assistant and most clearly demonstrated by safely instructing another trainee in the conduct of the operation. Trainees’ proficiency in an operation is only clearly demonstrated once they are able to safely act as a teaching assistant in that capacity.
- L aparoscopic Colectomy: Basic Operative Principles Dissection in bloodless planes Proximal vessel ligation Adequate margins Adequate lymphadenectomy Appropriate training and skills of surgeon Dissection in anatomic planes avoids unnecessary bleeding problems and minimizes the blind use of electrocautery. The goals of laparoscopic colectomy are the same as for open surgery. Laparoscopic colon surgery requires a higher degree of special dexterity and technical skills. An initial training period is usually required to become proficient in these procedures. The learning curve in laparoscopic colectomy ranges from 30 to 70 cases . This refers to acquisition of skills necessary to completely eliminate &quot;failure &quot; or reduce it to a minimum.
- Residents are now expected to master both the laparoscopic and open version of each operation during the unchanged 60-month training interval that previously consisted only of education in open procedures. Basic laparoscopic operations such as cholecystectomy, appendectomy, and diagnostic laparoscopy are often taught to surgical residents, who do not have experience with the equivalent open operation. Learning advanced laparoscopic procedures is much more difficult without such prior experience. Laparoscopic surgical trainees not only need to learn the conduct and exposure of each procedure but must also learn the uniquities of minimally invasive surgery, such as adjusting to depth perception difficulties arising from two-dimensional (2D) imaging, overcoming the fulcrum effect created by placing instruments through trocars in the abdominal wall, and contending with the visual illusions and ergonomics difficulties created by mirror imaging.
- As opposed to conventional open surgery, where the surgical educator is able to guide the conduct of the operation, during laparoscopic procedures the educator is often using his hands for retracting tissues out of the field of view of the camera in addition to operating the telescope. Such maneuvers limit the minimally invasive surgeon’s ability to point to the monitor or the operative field and direct the operation. Additionally, not having free hands makes it difficult to prevent a resident from performing an undesired or potentially harmful maneuver. In order to be able to use his hands for corrective purposes, the teacher may need to set down his instruments, change his position with the surgical student, and then change positions again, This may result in significant blood loss or the need to convert to an open operation. One antidote to the problems incurred by not having the hands of the minimally invasive surgeon available to present effectively would be to ensure the presence of additional surgical assistants when teaching procedures. Another profound difference between open and laparoscopic surgery is realized in the demonstration of tissue techniques. In laparoscopic surgery the instruments utilized to divide, coagulate, and staple tissues are also designed to be used by a single operator. Although such single-user design may be advantageous to the experienced surgeon and minimize the need for assistance, instruments such as ultrasonic dissectors, clip appliers, and surgical staplers do not allow the teacher to direct device placement beyond verbal cues. In open surgical procedures, tissues are often clamped on either side, divided and tied, allowing the surgeon to intervene at several points throughout the task to ensure that steps are completed successfully. Comparatively, using laparoscopic instruments, e.g., an ultrasonic dissector provides the teacher with little opportunity to correct the maneuver once it has begun as the tissues are divided and ligated simultaneously.
- Laparoscopic colectomy presents its own unique challenges to training in addition to those of laparoscopic surgery in general. While many operations occur in a single anatomic location, colectomy often requires the surgeon to operate in multiple quadrants of the abdomen. Operations in which the pathology is fixed in position allow the surgeon to optimize trocars and utilize fundamental principals of laparoscopy, e.g., triangulation, to optimize the ergonomics of the procedure. In contrast, colectomy will often necessitate mobilizing the resected portion of the bowel as well as bowel proximal and distal to facilitate anastomosis. Therefore, trocar placement may be optimal for the majority of the operation but less desirable for other portions. Thus, the surgeon may operate with less desirable views of the anatomy for portions of the procedure or alternatively may elect to place additional trocars. The technical demands of laparoscopic colectomy have limited its widespread adoptance in the surgical community. While 20 percent of all colectomies performed annually are laparoscopic, training residents in this α advanced operation has been hampered by its technical demands.
- Laparoscopic colectomy also requires advanced surgical techniques, e.g., dissection, vessel ligation, and creation of an intestinal anastomosis. Furthermore, not all laparoscopic colectomies require the same patient positioning and port placement. Optimal port locations vary significantly for left, right, transverse, and subtotal colectomies. Details as simple as specimen extraction, which are performed without much concern during benign disease, require special attention and training as port site recurrences at the specimen extraction site have been reported.
- Short courses offer the surgical trainee the opportunity to participate in an intensive experience in laparoscopic colectomy within a limited period, typically two to three days. Generally, these short courses are designed to expose the trainee to the basic skills necessary to perform laparoscopic colon surgery as well as broad information regarding the procedure. The basic short-course curriculum involves a combination of lectures, demonstrations, and hands-on experience. Endorsed guidelines for short courses have been published by the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons.
- The basic curriculum typically should include: a didactic session of about eight hours during which instrumentation, operating room setup, insufflation, anatomy, tissue handling, complications, and indications for surgery are discussed. Separate didactic sessions for both right and left hemicolectomy should be included. Operating room setup, review of complications, a video demonstration, as well as discussion of the hand-assisted approach should be emphasized. The basic laparoscopic skills covered in the curriculum should include trocar insertion, tissue handling, camera control, energy sources, vascular control, bowel division and anastomosis, retraction, and positioning.
- The laboratory session should make use of both porcine and human models. Appendectomy, rectal mobilization and division, surgical stapling using circular staplers, small bowel resection with intracorporeal anastomosis, end colostomy, splenectomy and small bowel suturing would constitute the procedures simulated in the basic porcine laboratory. The laboratory session for advanced training should use the human cadaver model to provide trainees with the opportunity to perform right colectomy, left colectomy, transverse colectomy, and rectal resection. In the laboratory session stress should be on key technical points of the operations including ureter identification, nerve preservation, hepatic mobilization and splenic flexures techniques, small bowel retraction, and omental preservation and resection. Ι t is imperative that faculty have performed a minimum of fifty prior laparoscopic colon resections and must have experience in teaching laparoscopic colectomy to residents, fellows, or other practicing surgeons. Upon completion of these courses, each trainee should receive clear documentation of participation and competency in an evaluation that rates performance of each task through a range from unsatisfactory to superior skill demonstrated. That such an evaluation may proffer a caveat to short courses being viewed as ends in and of themselves is presented by Sidhu et al. who investigated the accuracy of practicing surgeons’ self-assessment of technical skills upon completion of such techniques as colon mobilization, mesenteric dissection, and vascular ligation, which were videotaped during a 2-day laparoscopic colectomy course set in an animal laboratory and independently assessed by 2 certified surgeons blinded to subjects’ identities. A global rating scale instrument was used for evaluation, and comparison of the assessments indicated that participant surgeons on a consistent basis overrated their performances.
- Complete understanding of the instrumentation, endomechanical devices, and energy sources is mandatory and can be easily learned in an environment remote from the operating room. Skill mastery can be achieved even through use of rudimentary box trainers. Familiarity with these devices can be gained without the use of a telescope or monitor, as the student must familiarize himself with the equipment in three dimensions prior to utilization in a video-based 2D application. Acquisition of additional skills will require the use of a laparoscopic telescope and video monitors in the skills laboratory. Video trainers allow trainees to transition to the use of advanced laparoscopic equipment in a three-dimensional (3D) setting. Laparoscopic suturing, stapling, and tissue approximation techniques may be practiced and refined using rubber or foam tubing as human tissue simulations. Additionally, this type of simulation allows the resident to practice deployment of endomechanical devices in the 2D view. Competence in each facet of the operation must be mastered first in three dimensions, followed by competence in two dimensions. Human cadaveric models—while not adequate for instruction in the principles of hemostasis—provide the most realistic simulation comparative to a live operation. A recent survey demonstrated that, despite their cost, cadaver courses are most efficacious. A laparoscopic colon surgery workshop took place under the auspices of the American Society of Colon and Rectal Surgeons for one day over a three-year period. That the course used cadaver models was the most important factor for participants, who not only highly recommended the course for other surgeons but also advanced the belief that completing such a course should be a required requisite for the granting of hospital privilege.
- Though no single ideal simulated colectomy exists, recently, a hybrid simulator used for left-sided laparoscopic colectomy training was reported on. This initial study established the simulator’s ability to differentiate between experts and quite experienced novices in this procedure necessitating advanced laparoscopic skill. Also, trainees gain the capability to experience the complete procedure using the same instruments that would be used in the OR while at the same time acquiring instantaneous objective performance feedback. The result, however, of prerequisite simulation training will be that trainees will have demonstrated competency in an operation prior to scrubbing for the first time. Thus, the teaching paradigm for the minimally invasive surgical trainee can be said to be simulate many, see many, and finally do one.
- Preceptorships represent an excellent model by which surgeons may gain competence in laparoscopic colectomy. Direct interaction with an experienced surgeon during actual cases allows the trainee the opportunity to appropriately struggle with difficult portions of an operation without risking patient injury. Several studies describe significant increases in residents being exposed to and involved in colectomy procedures with a dedicated laparoscopic colorectal surgeon on staff, with one noting the only drawback being that the extent of resident participation caused variance in operative times. The judicious proctor will recognize the trainee’s limitations in experience and training. This means that immediate constructive comments and criticism to facilitate the trainee’s completion of a given task will be provided. Also, if necessary, the preceptor may perform a difficult component of the operation that the trainee is unable to perform safely. However, the learning that occurs during these exchanges is critical to the trainee’s progression. Appropriate levels of supervised struggling that do not result in patient harm is essential to the acquisition of new knowledge and the advancement of the surgeon’s skills. Such a period of difficulty must be considered necessary for better understanding of the maneuvers required to perform the procedure. Learning the skills of laparoscopic colectomy under the supervision of a preceptor has been recognized as a superior form of education as it results in a decreased incidence of conversion to an open procedure by more than threefold and also minimizes trainee frustration, a frequent reason for surgeons to abandon new techniques. Telementoring may provide an efficient method allowing preceptorship under otherwise forbidding situations by allowing scenarios such as an expert surgeon in one location being able to provide verbal instruction to an inexperienced surgeon in another location. Among the advantages of telecommunication are that preceptors can be more readily available for intraoperative consultation without the expense of travel. Certainly, a disadvantage of telementoring is the inability of the preceptor to manipulate the surgical instruments and perform a task that is not able to be completed by the bedside surgeon. Telerobotic assistance has been suggested as one remedy for that disadvantage
- Although certain principals translate between and among left colectomy, right colectomy, transverse colectomy, and proctectomy, each of these procedures requires some unique skills. As a result, competency in one type of laparoscopic colectomy does not infer competence in all types of colectomy.
- Fellowship training in laparoscopic colectomy is the most comprehensive method of mastering the surgical technique. Fellowships over the course of one to two years provide a well-rounded curriculum that educates trainees in appropriate indications and contraindications, technical skills, postoperative care, and follow-up. Hyman et al have indicated that those fellowship-trained in advanced laparoscopic bowel procedures were more likely than other fellowship trained surgeons to perform a majority of laparoscopic resections. Most laparoscopic surgeons feel that such a fellowship is the best method of attaining competence in laparoscopic colectomy. Fellowship programs provide trainees participatory opportunities over the course of one to two years to attain competence equivalent to an expert surgeon in many procedures. However, the practicing surgeon may have difficulty in making the commitment to pursue fellowship training due to the potential impact on an existing surgical practice.
- The learning curve for both laparoscopic right and left hemicolectomy has been reported to be in excess of fifty cases for each procedure. A focused curriculum that utilizes surgical simulators, animal laboratories, tutorial sessions, and direct resident feedback has been shown to be an effective method to train residents in laparoscopic colorectal surgery so that they attain equivalent operative times, conversions, and hospital stay as expert surgeons with an average resident volume of 17 cases. It should be noted that well over half of the graduates (62%) cited hand-assisted techniques as vital to performance of both their first laparoscopic colon resection and colectomy
- This is a retrospective study of the first 100 patients undergoing laparoscopic colon and rectal resections by a single attending surgeon following a dedicated colorectal surgery fellowship. For the purposes of analysis and comparison, cases were divided into early and late groups. The first 50 cases comprised the early group, while the second 50 cases were defined as the late group. As these procedures have become a more significant part of residency and fellowship training, attention has turned to what role specialized fellowship training has in meeting these training demands for the colorectal surgeon. We hypothesized that the laparoscopically trained colorectal fellow was adequately prepared to perform safe and efficacious laparoscopic colon resection during the first year of independent practice. In this series, we have examined the first year of colon and rectal resections of a colorectal surgeon. We assessed characteristics over the first 100 cases and used these parameters to evaluate the operations with respect to safety, efficiency, and short-term outcomes. Overall, the early and late experience involved a similar distribution of case type and operative indication. Approximately half the patients in either group underwent a resection for colon or rectal malignancy. As a measure of intraoperative safety , we examined blood loss and conversion rate. There was no significant difference demonstrated between the early and late operative experience. The next element of safety is the postoperative morbidity and mortality. With regard to all measures of morbidity, including superficial infections, there were no significant increases in risk to the patient from the early to late experience. In addition, overall 30-day mortality was statistically similar between the 2 groups. Additionally, LOS is an early surrogate for postoperative outcome that is frequently espoused as one of the benefits of laparoscopic surgery. Notably in this series, there was no significant difference with regard to postoperative stay in either the early or late operative experience. Next, we measured the efficacy of colorectal resection for malignancy. An adequate lymph node should act as a measure of oncologic adequacy. With regard to both right- and left-sided resections, there were greater than an average of 15 lymph nodes obtained in both early and late experiences. There was no significant deviation in this throughout the first year of operative experience. In addition, the proportion of margin positivity (radial and/or linear) was similar in both groups. The final parameter that we examined was operative efficiency. All of the above findings supported the conclusion that colorectal training with a focus on laparoscopic and minimally invasive approaches has adequately prepared the surgeon to perform both safe and efficacious colon resections. Prior investigators have presented data that operative time alone is not an appropriate surrogate for the learning curve. Rather, we find that it is a measure of operative efficiency and overall comfort with these technically demanding procedures. These data have demonstrated an obvious reduction in the overall time required to perform a laparoscopic colon resection that occurs with experience over the first 100 cases In examining the first 100 cases of a fellowship-trained colorectal surgeon, we find that there is no difference in mortality, morbidity, blood loss, node survey, or length of stay between early and late cases following colorectal fellowship. Alternatively, operative times decrease significantly over the first 100 cases. These data support the conclusion that laparoscopic experience during colorectal fellowship adequately surpasses the learning curve in regard to safety and outcome, whereas the surgeon continues to increase operative efficiency over the first year of practice.
- Objective To analyse the outcome of laparoscopic appendicectomy and right hemicolectomy and see if the surgical approach to the former can be applied to the latter. Method A prospective electronic laparoscopic database identified 330 appendicectomies and 78 right hemicolectomies (using this approach). Results 330 patients underwent laparoscopic appendicectomy; (82%) were performed by trainees. The median operative time for trainees was 35 min with a conversion rate 2%. There were no intra-operative complications. The postoperative complication rate excluding minor wound infection (5.5%) was 1.5%. There were no deaths. The median hospital stay was 2 days. 78 patients underwent laparoscopic right hemicolectomy ; trainees performed parts thereof in the majority or all of the surgery in 25 cases. The median operation time was 55 min: trainees 115 . There was one conversion. The median hospital stay was 4 days . There were two readmissions for wound sepsis and small bowel obstruction and three deaths (3.8%). Conclusion Laparoscopic appendicectomy is a safe, predictable, easily learnt operation and an ideal model for learning the skills and principles required for more advanced laparoscopic colorectal interventions and in particular, right hemicolectomy.
- Competence in laparoscopic colectomy rightfully has generated a good deal of discussion. Complication rates, conversion rates, operative times have been advanced as assessments for measuring ability with respect to performance of laparoscopic colectomies, though a recent study indicated that operative time does not necessarily decrease with experience and positive clinical outcomes are not necessarily associated with decreased operative times, as more experienced surgeons willingly take on the more complicated cases. Additionally, Hyman et al have put forth the case that neither case volume nor training but only the actual tracking of outcomes is adequate for assessment of competency to perform laparoscopic bowel resection. A focused curriculum during a general surgical residency offers one solution to obtaining competency
- Approximately 250,000 colonic resections are performed each year in the United States. Currently, the average general-surgery resident finishing a training program in the United States has performed fewer than one laparoscopic colon operation during training. Either our educational programs and teaching methods must be modified to take on the challenges to come, or an increased number of laparoscopic experts must be trained to perform colectomies. We suspect that both will happen. Although the frequency of open colon resection is unlikely to diminish to the degree that open cholecystectomy has, the number of laparoscopic colon resections will increase dramatically over the next decade. Many proponents suggest that 70 percent of small- and large-bowel operations can be performed with the use of minimally invasive techniques. The world of colorectal surgery will have to adapt. Training in laparoscopic colectomy represents a unique challenge. Many training models exist that can be used to various extents based on the surgeon’s prior experiences and training. However, use collectively of these existing training tools will best prepare the novice for performing advanced operations such as laparoscopic colectomy. Residency training alone infrequently provides adequate experience to safely perform laparoscopic colectomy. Short courses and preceptorships may be adequate for those with prior laparoscopic experience, whereas fellowships may be necessary for those with lesser experience. However, regardless of the method of training, it is mandatory for the surgical trainee to demonstrate procedural competence evidenced by acceptable operative times and morbidity rates prior to commencing in independent practice.