Minimally invasive surgical practice: a survey of general surgeons in Ontario.
BACKGROUND
With the rapidly evolving techniques for minimally invasive surgery (MIS), general surgeons are challenged to incorporate advanced procedures into their practices. We therefore carried out a study to assess the state of MIS practice in Ontario.


METHODS
A questionnaire was mailed to 390 general surgeons in Ontario. It addressed the surgeon's practice demographics, performance of both basic and advanced MIS procedures, the factors influencing this practice and the means of obtaining MIS training.


RESULTS
Of the 390 general surgeons surveyed, 309 (79%) responded. Thirty-six of these were retired and were excluded from the analysis, leaving 273 available for study. The average age in the study group was 49.7 years; 247 (90%) were men. Of 272 who responded to the question, 116 (43%) had subspecialty training. The average surgeon's operating room (OR) time was 1.5 d/wk and the average waiting time for elective procedures was 4 weeks. We found that 257 (94%) respondents performed basic laparoscopic procedures, and 164 (60%) performed appendectomy; 135 (49%) performed at least 1 advanced laparoscopic procedure in their practice, although only 30 (22%) of these performed inguinal hernia repair. Using a Likert scale, we found that the most important factors influencing the incorporation of advanced laparoscopic procedures into surgical practice were a lack of OR time (median 4), lack of OR financial resources (median 4) and lack of training opportunities (median 4). Of surgeons responding to questions, 161 (64%) of 251 felt that the present medical environment did not allow them to meet standard-of-care requirements; they felt that it was the responsibility of academic surgical departments (214 [80%] of 268), the Canadian Association of General Surgeons (177 [68%] of 262) and the Ontario Association of General Surgeons (141 [53%] of 264) to provide continuing medical education courses for MIS training.


CONCLUSIONS
The ability of practising general surgeons to incorporate advanced MIS procedures into their surgical practice remains a complex issue.
Southern Arizona Center for Minimally Invasive Surgery, Tucson, Ariz., USA.
Patrick M
PM
Chiasson
David E
DE
Pace
Christopher M
CM
Schlachta
Joseph
J
Mamazza
Eric C
EC
Poulin
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000379:methods / Q000706:statistics & numerical data*; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D013514:Surgical Procedures, Operative / Q000193:education / Q000592:standards / Q000639:trends; D011795:Surveys and Questionnaires; D013996:Time and Motion Studies; D016896:Treatment Outcome; D014850:Waiting Lists