ISGE VIDEOS

Tamer Seckin:  Hi, I’m Dr. Tamer Seckin.  We are here in Osaka.  I have a very important guest with me whose respect and admiration I have for many years as a medical student back in Turkey.  I have bought a series of books that he has edited.  It was probably 13 volumes or 12 volumes about gynecology and obstetrics.  I have John J. Sciarra from Chicago, who is a member of our ISGE board now and who is well-known around the world for his work to the profession that he has given some much of his life fully.  We would like to use some of his experience for our members, maybe he has some messages as young doctors they are all over the world, as young surgeons, he must share some of his highlights in his life for the future.  Dr. Sciarra, welcome.

 

John J. Sciarra: Thank you.  One of the things that is really important in terms of laparoscopic surgery is that the skills that are necessary to do safe and effective laparoscopic surgery are really quite different from those skills that are useful in general obstetrics and in general surgery, and because of this, we have tried to develop new methods for teaching endoscopic surgery to residents and to fellows and it has been a slow evolutionary development because many places do not have the capabilities of providing animal operating rooms by providing the didactic teaching necessary to develop skills for endoscopic surgery.  One of the things that I would like to stress in terms of developing skills for endoscopic surgery is that there are certain steps.  One starts as a novice, moves upto the position of an intense beginner, then moves into the era of being a competent surgeon or efficient surgeon, eventually an expert and then a master, and you can equate these steps with a residency program, so that when one enters the residency program one starts as a novice, then maybe the second year becomes an intense beginner, third year begins to be competent, and then from that point on requires real interest and desire to do endoscopic surgery.  Some residencies do this very well, but most still do not, and I think that has been an unfortunate failing of our system because we expect everyone to make initial residency program to love to do everything and today that is not possible and as a result laparoscopic surgery in practice has not been heading in gynecology as it has in general surgery where, you know, if you jump to laparoscopic surgery, you do not get referrals.  In our system, which does not depend as much on referrals, one can do abdominal surgery and carry on successful practice without doing a lot of endoscopic surgery.  So, I think just a small way to develop this topic that we really have to look at new methods for teaching endoscopic surgery to developing a really good very proficient that can then take this to every hospital within the country; it does not exist at the moment in the US.

 

Tamer Seckin:  In your experience, in speaking about United States, obviously that is where we have been practicing, what is the position of malpractice and endoscopic issues that we face as far as limiting the advancement of young professionals who are eager to do laparoscopic surgery yet are afraid or find true guidance?

 

John J. Sciarra: I think this is very true not only in our country, but it is just beginning to be true all over the industrialized countries where malpractice has actually begun to be focused on the development of technology and people who are not well trained in the technology have put their patients at an increased liability and I think at least in big cities in the United States where practice is concerned, it is a great concern for many surgeries and may avoid procedures such as laparoscopic surgery because they don’t have the skills to do it safely and efficiently.  It does change practice patterns.

 

Tamer Seckin:  And my last question again is about training, which we look for you as one of our teachers all the time and experienced in this subject.  Do you believe that there are enough fellowship programs for GYN endoscopy in United States and following up on the same question, do you think ISGE may have some input in developing some fellowship programs in United States or for some of our members even abroad?

 

John J. Sciarra: There are relatively few fellowship programs in advanced endoscopic surgery.  Somewhere between 14 and 18 at the moment in the United States and these programs can only take in a limited number of fellows per year, so that the number of individuals graduating with advanced laparoscopic skills, it is really for a country of our size, quite small.  Whether or not the ISGE has the thought of developing endoscopic training programs elsewhere is a hard question to answer because the very ability of skills around the world is tremendous.  In many countries, like the US, the UK, and countries in Europe, skills are high.  In virtually all other counties though skills are for the most part pretty low, and so that the training that is being directed in the developing countries is really a basic endoscopic surgery, not an advanced endoscopic surgery, there is an enormous difference between the two.  The ISGE’s focus has been on training of basic endoscopic surgery and I think that is probably where it should be.