Development Perspectives
An analysis of the current situation and development perspectives of laparoscopic surgery was carried out, based on the experience obtained in a general surgery service. The positive effect that this has produced in the surgical activity is pointed out, as well as the organizational, methodological difficulties and in the training of specialists and residents that still exist and slow down the development of the specialty.
For minimally invasive surgery technique many of them have not received practical training with simulators resembling Laparoscopic Trainer.
Writers prepared the analysis of present condition and the growth sides of laparoscopic surgery from the experience obtained in a general surgery department. Laparoscopy had a positive result in surgical activity, as well as the shaping, methodological problems and in the training of specialists and residents that nowadays remain and the development of the specialty.
Acquisition of Surgical Skills
The acquisition of surgical skills is a matter of the utmost importance during the learning period involved in completing the specialty of Urology. For this reason, the progressive implementation of laparoscopy in our healthcare activity should be followed by a stepped learning plan, in response to this new training need, which should be carefully designed so as not to cause any harm, in any case, to patients operated with this new surgical approach modality.
Starting from the acceptance of this premise, each case and each indication in particular should be approached, ensuring that the basic principles of medical ethics (beneficence, non-maleficence, justice and autonomy) are preserved. To do this, the probable risks will have to be weighed according to one's own experience or directly related to the type of intervention. In this regard, this article outlines the different options to carry out an ethically acceptable training plan in urological laparoscopy, taking as a point of reference the experience in laparoscopic prostatectomy. Likewise, the justifying reasons for the so-called "programmed conversion" and, finally.
Skills of Importance
Training functioning skills are of most importance to training, specifically in the period of time of the job. Because of that, the overview of laparoscopy in our surgical action must be monitored by a careful planning of advanced preparation as an answer to this new need that would be well planned trying not to harm in so forth likely way to the patients worked with this new modality of surgical achievement.
In this sense, each case and every sign of laparoscopy should be explained independently, considering the fundamental standards of clinical morals (advantage, no wrathfulness, equity and independence). Along these lines, it will be important to choose about potential dangers because of the experience of the specialist or because of the methodology of medical procedure. In this article, various decisions of preparing plannings in laparoscopy are expressed taking as a kind of perspective the involvement with laparoscopic prostatectomy, reasons of "arranged reconversion" are uncovered and, at last, the writers clarify the conversation about the subject and the degree of data proposed to the patients searching for the best prospects of decision making by the patients.
Methodological and Management Difficulties
A very peculiar situation arises in the specialty of General Surgery, which in my opinion does not promote its development, but on the contrary, it hinders it. This is related to a double leadership and subordination within the same specialty: on the one hand, the Minimum Access Surgery Advisory Group is the one that defines the strategy in everything related to laparoscopic surgery, as well as maintains control of the instruments and other resources of general surgery; and on the other, the Advisory Group of the Specialty of General Surgery has the same prerogatives but only in open surgery.
It is understandable that this was the case in the first years of assimilation of technology, due to the need for its rapid acquisition and introduction; After 13 years have passed, this dichotomy still remains and, in my view, it has affected and is affecting the harmonious development of the specialty. This causes, in practice, the fragmentation of surgery services in two aspects, when, on the contrary, they should function as a monolithic and organic unit, which is essential in a specialty as comprehensive, dynamic and complex as general surgery. Although they are different approaches, they are performed by the same surgeon and in the same specialty. If not unified, this ambivalence will increase due to the development of the specialty itself.
Conclusions
The incorporation of laparoscopic surgery techniques has meant a qualitative leap in the surgical activity of the specialty of general surgery, but there are still organizational and methodological difficulties in the training of specialists and residents, which slow down the development of the specialty, since which is necessary to give a solution.
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