Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Nicola De’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chirica, Lorenzo Cobianchi, Federico Coccolini, Raul Coimbra, Christian Cotsoglou, Mathieu D’Hondt, Dimitris DamaskosBelinda De Simone, Salomone Di Saverio, Michele Diana, Eloy Espin‐Basany, Stefan Fichtner‐Feigl, Paola Fugazzola, Paschalis Gavriilidis, Caroline Gronnier, Jeffry Kashuk, Andrew W. Kirkpatrick, Michele Ammendola, Ewout A. Kouwenhoven, Alexis Laurent, Ari Leppaniemi, Mickaël Lesurtel, Riccardo Memeo, Marco Milone, Ernest Moore, Nikolaos Pararas, Andrew Peitzmann, Patrick Pessaux, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Frederic Ris, Tyler Robison, Massimo Sartelli, Vishal G. Shelat, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Ellen Van Eetvelde, Yoram Kluger, Dieter Weber, Fausto Catena

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Background: Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS.

Methods: This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements.

Results: Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency.

Conclusions: Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.
Original languageEnglish
Article number11
Number of pages23
JournalWorld Journal of Emergency Surgery
Publication statusPublished - 27 Jan 2023


  • Emergency surgery
  • Minimally invasive surgery
  • Robotic surgery
  • Laparoscopy
  • Training curriculum in surgery

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