With the improvement of minimal invasive, even when we need to do open it will be different from old open surgery. The younger surgeons will be different in open than it was in the past. If this is better or not we won´t know, it will be different.

Dear Sir. should we trained the tradional procedures, or practice updated?

I think, traditional surgery would remain in high demand. Especially in areas that are resource poor.

Traditional surgery is the basic

Younger surgeons should be trained in bothMIS and traditional surgery.In open surgery they should know hand sewn and stapler,ligatures and harmonics so that they can work wherever placed.So it's more difficult for them

Dear @Samia Thats what I beleive in, but some MIS surgeons had impression of superiority even to those who learned them basics, though they cant deal with cases that need expert surgeon in open surgery.

best regards.

@Swagata totally agree with you, tradional procedures can solve a problem and help when unecpected event occur

The so called 'traditional' surgery is the gold standard and there is no way it can be done away with. Only with confidence in the open surgery, can the skills be transferred to minimal access. Because, if there is a problem in minimal access, a confident surgeon would not hesitate to take up the backup (open surgery). As open surgery is a stepping stone to minimal access, the question of superiority is out of question.

'Whether it is open or minimal access is a lesser matter, what is of greater concern is the surgeon's attitude in treating the primary condition as per the prescribed standard of care'.

Dear Sir...

The point is that the practice of basic surgery is less because the extention of use of MIS, so the newly qualified surgeon will get less chance to perform open surgery, which is as important as the skillful MIS. fhi

Not all hospitals have the ability to perform minimally invasive surgery. Minimally invasive surgery does not always give a better result than open surgery, for example, for germ cell tumors of the ovaries. Sometimes you need to switch to an open operation due to the difficulties that have arisen. The surgeon must be proficient in both technologies.

He should know the basics, before advanced

Surgery is a constantly developing field. When I began, my mentors could confidently do any surgery in the textbook. As knowledge and technology progress, the doctor is forced to specialise more and more. With that comes MIS techniques. Older surgeons may say everyone should be able to do a burr hole, stabilise a fracture, remove a thyroid, but in most places today that might be considered malpractice. We have to accept that MIS is here to stay, but only the techniques that prove better results in the long run.

totally agree.. it is the same here..

Teaching residents must include external approaches, cadaver dissections are mandatory. Today the endoscopic tendency is the rule but sometimes both

techniques must be complementaries@azzawi

Every kind of procedures have a place in the treatment of patients and the surgeon must use the best for the patient (personalized surgery) For example ,Robotic surgery for gallbladder is not indicated for the cost and not superiority ,Some kinds of trauma due to the emergency situation, it is obvious, robotic procedure is not indicated. I think residents must learn all the kind of procedures to be used in specific situations .

Totally agree with this profissional opineon.

regards

Azzawi Hadi First of all, I must congratulate you for initiating this burning and most confused issue in current surgical practice following MIS in the 1990s. Ever since the practice of surgery has undergone a sea change. Old procedures have been ruthlessly challenged. It has been a worry when I used to hear loud-mouthed lectures about "Today, laparoscopy is the gold standard for cholecystectomy". But they never elaborate, "What is meant by their gold standard?" It is a sad and misleading statement which, to my mind smacks of hubris and self-aggrandizement only to infuse a sense of inferiority in others who, for whatever reason fail to complete it by lap. It will often or sometimes force or lead the operating surgeon to continue the difficult procedure by lap and plunge in an irretrievable disaster. If anything, the gold standard phraseology should either be desisted or condemned to use. The only "Gold Standard" to my mind is a live patient and we certainly are not expected to play with it only to satisfy our surgical hubris (pun added).

Now coming to the training module of budding surgeons, I feel that every young surgeon must have full exposure to "open surgical technique first before exposing them to MIS". Every surgeon will love to see their patient alive at the end. If one is incompetent to do it, either refer the patient or learn it before embarking on it. I am an old man trained initially in open surgery and took over to lap in 1994 when there were no training centers in India and I trained myself equipped with my long experience in open surgery. Initially, I met with few mishaps but I could get over them by open technique with no ill to patient. No surgeon should ever feel bad in conversion, rather the surgeon must ensure the safety of the "life" of the patient concerned. The surgeon must remember that it is not "a case" but "a valuable life", which can only be preserved but cannot be retrieved once lost - once lost, lost forever. With regards to all the participants here,

thank you @Om Prakash.

you explain the need behind this, question, If all centers focused on MIS where did the young surgeon will practice basic open surgery. the other point is, when the surgeon faced the complicated cases, that should be converted, and he is not trained to do it, what will be the end of the tragic situation. many surgeons lost their patients because they dont abort MIS and convert to open..

regards.

I believe that the open, laparoscopy and robotic surgery will coexist for a long time. However, the surgical training should focus in every aspect of these approaches. We can teach open cholecystectomy during an open hepatectomy or teach open gastrectomy during an open classic Whipple. Anyway, the future surgeons will need to train and learn from all sources but minimally invasive surgery came to stay and will become the standard of care for many surgical procedures.

Both running in a parallel ways.

Please see

http://www.jcmrp.eg.net/article.asp?issn=2357-0121;year=2020;volume=5;issue=4;spage=375;epage=378;aulast=L.

I agree with Om Prakash Sudrania: ..."that every young surgeon must have full exposure to "open surgical technique first before exposing them to MIS"..."

Dear Azzawi Hadi

The rise of minimally invasive surgery (MIS) has indeed revolutionized surgical practice, offering numerous benefits such as reduced recovery times, smaller incisions, and lower risk of complications. However, this shift also raises important questions about the future of traditional, open surgery and the training of new surgeons.

The Role of Traditional Surgery:

Balancing Training in MIS and Traditional Surgery:

• Curriculum Design: Surgical training programs should ensure that while MIS skills are emphasized, trainees also gain substantial experience in open surgery. This might involve dedicated rotations, simulation-based training, and supervised surgeries to ensure that skills are retained.
• Mentorship and Continuing Education: Experienced surgeons who are proficient in traditional techniques should mentor younger surgeons, sharing their expertise and insights. Continuing education and refresher courses can also help maintain proficiency in open surgery.
• Hybrid Approaches: Some surgical cases may benefit from a combination of MIS and open techniques. Training in these hybrid approaches can bridge the gap between the two methods and prepare surgeons for a wider range of scenarios.

Conclusion:

While the trend towards MIS is likely to continue due to its many advantages, the practice and training of traditional open surgery should not be neglected. A balanced approach that integrates both MIS and traditional techniques will produce surgeons who are not only skilled in the latest technology but also capable of handling complex cases where traditional methods are required.

This ensures that the next generation of surgeons remains adaptable, versatile, and fully equipped to provide the best care for their patients, regardless of the circumstances.

Must be practiced and taught ;prst they fall in tragic situations. Ihave witnessed surgeons killing patients just b'cause they had no experience of open surgery.

I agree with Dr Sudrania that I also witnessed situations in which surgeons with no experience in traditionasl surgery trying to perform minimally invasive surgery and even when complications succeed they try to stay with the method try not to convert to open procedure with tragical end

I also agree totally with Volodymyr Dzhyvak