title: The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period.
abstract: BACKGROUND
  Although minimally invasive surgery (MIS) has been quickly embraced, the introduction of advanced procedures appears more complex. We assessed the evolution of MIS in the province of Quebec over a 5-year period to identify areas for improvement in the modern surgical era.
  
  
  METHODS
  We developed, test-piloted and conducted a self-administered questionnaire among Quebec general surgeons in 2007 and 2012 to examine stated MIS practice, MIS training and barriers and facilitators to the use of MIS.
  
  
  RESULTS
  Response rates were 51.3% (251 of 489) in 2007 and 31.3% (153 of 491) in 2012. A significant increase was observed for performance of most advanced MIS procedures, especially for colectomy for benign (66.0% v. 84.3%, p < 0,001) and malignant diseases (43.3% v. 77.8%, p < 0,001) and for rectal surgery for malignancy (21.0% v. 54.6%, p < 0.001). More surgeons practised 3 or more advanced MIS procedures in 2012 than in 2007 (82.3% v. 64.3%, p < 0,001). At multivariate analysis, the 2007 survey administration was associated with fewer surgeons practising advanced MIS (odds ratio 0.13, 95% confidence interval 0.06-0.29). In 2012, more respondents stated they gained their skills during residency (p = 0.028).
  
  
  CONCLUSIONS
  From 2007 to 2012 there was a significant increase in advanced MIS procedures practised by general surgeons in Québec. This technique appears well established in current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development. Results from this study could be used as a baseline for studies focusing on ways to further improve the MIS practice.
authors.affiliation: The Division of General Surgery, Sunybrook Health Sciences Centre - Odette Cancer Centre, and the Department of Surgery, University of Toronto, Toronto, Ont.
authors.forename: Julie
authors.initials: J
authors.lastname: Hallet
authors.affiliation: The Department of Surgery, Université Laval, Québec, Qué
authors.forename: Olivier
authors.initials: O
authors.lastname: Mailloux
authors.affiliation: The Department of Surgery, Université Laval, and the Department of Surgery, CHU de Québec - Hôpital Saint-François d'Assise, Québec Centre for Minimally Invasive Surgery (QCMIS), Québec, Qué.
authors.forename: Mony
authors.initials: M
authors.lastname: Chhiv
authors.affiliation: The Department of Surgery, Université Laval, and the Department of Surgery, CHU de Québec - Hôpital Saint-François d'Assise, Québec Centre for Minimally Invasive Surgery (QCMIS), Québec, Qué.
authors.forename: Roger C
authors.initials: RC
authors.lastname: Grégoire
authors.affiliation: The Department of Surgery, Université Laval, and the Department of Surgery, CHU de Québec - Hôpital Saint-François d'Assise, Québec Centre for Minimally Invasive Surgery (QCMIS), Québec, Qué.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gagné
mesh_terms: D000328:Adult; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011792:Quebec