‘What nonsense is he doing, these kind of heroics are unethical in surgery’
These were the first lines when laparoscopic surgery surfaced many years ago. The surgeons then thought it to be an act of negligence to operate patients while visualizing their intrabdominal structures with a camera. Of course, in those days the visual aids and instrumentation used were very primitive. As time passed, laparoscopic surgery for appendix and gallbladder were recognized as gold standard surgeries. With time came technological advancements as well. Optics improved tremendously so did methods of insuffulation as well as laparoscopic instrumentation. Along with this, grew surgical expertise as well. Unfortunately, even though adequate evidence exists to support these advancements, they are still not adopted and accepted by all. Most of the developed countries have adopted this change and are gathering increasing expertise performing a wide variety of surgery’s laparoscopically, the latest being transplant recipient of liver. However, there exists a large gap between these countries and the underdeveloped or developing countries. India, is far behind the rest of the world in technological advacements and adopting newer techniques. In a developed city like Mumbai which is our financial capital, use of laparoscopy is limited and those in their prime ie the baby boomers are resistant to change their years of practice. We remain oblivious to the technological advancements in the world around us. Even though young surgeons i.e. millennials are getting more equipped and trained with laparoscopic procedures there is a fear among the older generation who are reluctant to allow millenials to carry out such complex procedures.
Why is there reluctance to accept advanced laparoscopic techniques???
- It needs adequate training and expertise and done by an unexperienced person can be disastrous.
- Surgeons are comfortable with their outcomes of years of practice. The fear of failure as well as discomfort to try a new technique gets them out of their comfort zone.
- The fear of judgement by their colleagues in case they are unable to complete the procedure laparoscopically.
- The belief that laparoscopy compromises oncological safety despite data available suggesting the contrary.
- Lack of research and review of worldwide database and evading the practice of evidence based medicine.
- The cost of the procedure and the tremendous burden of healthcare costs to be bourne by the general public.
How can we overcome this?
Introducing review of data and research work into practice of surgeons is a must. If we are not aware of the latest developments how can we apply it. Understanding research papers and the quality of data available is the first step into the process. Practicing evidence based medicine is the key. Hospitals should organize visits of their surgeons to well recognized international and national centres who are peforming advanced laparoscopic procedures and who have data to support their techniques. This will enable a first hand visualization of the technique as well as create interest in adopting such practices in centres. Training of doctors especially in government instituitions will enable the best possible care to be provided to those unable to afford private care. Promoting young doctors who have trained extensively and building their confidence as well as seniors learning new techniques from the younger generation can also help to bridge this gap in health care management.