Having a global impact: MUHC-trained surgeons boost practice of minimally invasive surgery around world

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 its impressive skill set around the world. Its MIS training program has helped make the MUHC a leader in this increasingly common form of surgery.

 “When we started doing minimally invasive surgery (MIS) 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, but even so, we needed to train people in MIS-specific skills such as working in a two-dimensional space with the video camera outside the 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 different types of simulations,” says Dr. Feldman. “These let people learn from their mistakes. 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. For example, the MUHC has developed special simulations for procedures like hernia repair.

 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 round circles back and forth on pegs to get used to using the instruments based on visual input from a camera.

Dr. Neville is currently completing a one-year program in advanced laparoscopic skills, to qualify as a specialist in MIS surgery. “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  just as skillfully as open surgery.” says Dr. Feldman. “That’s something to be very proud of.”