title: Minimally invasive surgery adoption into an established surgical practice: impact of a fellowship-trained colleague.
abstract: BACKGROUND
  Practicing general surgeons adopt minimally invasive techniques using training opportunities such as weekend courses, videos, hands-on conferences, and traveling proctors with varying success. By integrating a fellowship-trained surgeon into an established practice, we show that minimally invasive techniques can be readily adopted.
  
  
  METHODS
  A retrospective review of operative reports from July 2004 through June 2008 obtained the number of laparoscopic and open appendectomies, colectomies, ventral/incisional hernias, and inguinal hernias performed by five practicing surgeons. Three time intervals were formed: 18 months before arrival of the MIS-trained surgeon, a 12-month transition period, and the 18 months following. Only cases performed by the five surgeons, and not by the MIS-trained surgeon, were included. A survey elicited the opinions of the five surgeons on various aspects of the transition, including barriers and effectiveness of different methods for learning MIS techniques.
  
  
  RESULTS
  A total of 4,016 cases were reviewed. The percentage of total cases performed laparoscopically increased from 12.1 to 48.3 %. Laparoscopic appendectomies significantly increased across time periods from 19 to 80 % (p < 0.0001). Adoption of laparoscopic ventral/incisional hernia repairs increased from 4.8 to 20.1 % (p = 0.0322). Laparoscopic inguinal hernias increased from 0.6 to 31.1 % (p < 0.0001). Finally, laparoscopic colectomies significantly increased from 25 to 52 % (p < 0.0001). Survey responses indicated that "mentoring by a colleague with MIS training" was superior to other methods for learning MIS procedures (p = 0.0327-0.0516).
  
  
  CONCLUSIONS
  The integration of a fellowship-trained MIS colleague into a general surgery practice resulted in a 300 % increase in the proportion of appendectomies, ventral hernias, inguinal hernias, and colectomies performed laparoscopically by the other members of the practice. When surveyed, the surgeons felt that mentoring by a colleague with MIS training was the most effective method for adopting MIS procedures into their practice.
authors.affiliation: Department of Surgery, Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214-3998, USA. e34dominguez@yahoo.com
authors.forename: Edward P
authors.initials: EP
authors.lastname: Dominguez
authors.forename: Cory
authors.initials: C
authors.lastname: Barrat
authors.forename: Lynn
authors.initials: L
authors.lastname: Shaffer
authors.forename: Ryan
authors.initials: R
authors.lastname: Gruner
authors.forename: Donald
authors.initials: D
authors.lastname: Whisler
authors.forename: Philip
authors.initials: P
authors.lastname: Taylor
mesh_terms: D005257:Fellowships and Scholarships; D006123:Group Practice; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000706:statistics & numerical data; D019060:Minimally Invasive Surgical Procedures / Q000193:education* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies