title: Training minimal invasive approaches in hepatopancreatobilliary fellowship: the current status.
abstract: BACKGROUND
  There has been an increasing role of advanced minimally invasive procedures in hepatopancreatobilliary (HPB) surgery. However, there are no set minimum laparoscopic case requirements.
  
  
  METHODS
  A 14-question electronic survey was sent to 82 worldwide HPB fellowship programme directors.
  
  
  RESULTS
  Forty-nine per cent (n=40) of the programme directors responded. The programmes were predominantly university based (83%). Programmes had either one (55%) or two fellows (40%) each year. Programmes (35-48%) had average annual volumes of 51-100 hepatic, 51-100 pancreatic and 25-50 biliary cases. For many programmes, <10% of hepatic (48%), pancreatic (40%) and biliary (70%) cases were done laparoscopically. The average annual fellow case volumes for hepatic, pancreatic and biliary surgeries were 25-50 (62%), 25-50 (47%) and <25 (50%), respectively. The average annual number of hepatic, pancreatic and biliary cases done laparoscopically by a fellow was 9, 9 and 4, which constitutes 36%, 36% and 16%, respectively, of the International Hepato-Pancreato-Billiary Association (IHPBA) requirement.
  
  
  CONCLUSIONS
  We surmise that the low average number of surgeries performed by minimally-invasive techniques by HPB fellows is not sufficient in today's practice. Should there be an increase in the minimal number of hepatic, pancreatic and complex biliary cases to 50, 50, and 25, with at least 50% of these performed laparoscopically?
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.
authors.forename: Gokulakkrishna
authors.initials: G
authors.lastname: Subhas
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
mesh_terms: D001660:Biliary Tract Diseases / Q000601:surgery; D005257:Fellowships and Scholarships / Q000639:trends*; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D010535:Laparoscopy / Q000193:education*; D008107:Liver Diseases / Q000601:surgery*; D010182:Pancreatic Diseases / Q000601:surgery; D013043:Specialties, Surgical / Q000193:education*