title: Training in Minimally Invasive Pancreatic Resections: a paradigm shift away from "See one, Do one, Teach one".
abstract: Increased incorporation of minimally invasive pancreatic resections (MIPR) has emerged into hepato-pancreato-biliary practice, however, no standardization exists for its safe adoption. Novel strategies are presented for dissemination of safe MIPR.
  
  
  
  An international State-of-the-Art conference evaluating multiple aspects of MIPR was conducted by a panel of pancreas experts in Sao Paulo, Brazil on April 20, 2016. Training and education issues were discussed regarding the introduction of novel strategies for safe dissemination of MIPR.
  
  
  
  The low volume of pancreatic resections per institution poses a challenge for surgeons to overcome their MIPR learning curve without deliberate training. A mastery-based simulation and biotissue curriculum can improve technical proficiency and allow for training of surgeons before the operating room. Video-based platforms allow for performance reporting and feedback necessary for coaching and surgical quality improvement. Centers of excellence with training involving a standardized approach and proctorship are important concepts that can be utilized in various formats internationally.
  
  
  
  Surgical volume is not sufficient to ensure quality and patient safety in MIPR. Safe adoption of these complex procedures should consider innovative mastery-based training outside of the operating room, novel video based coaching techniques and prospective reporting of patient data and outcomes using standardized definitions.
authors.affiliation: University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA. Electronic address: hoggme@upmc.edu.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: University Hospital of Graz, Graz, Austria.
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.affiliation: Methodist Health System, Dallas, TX, USA.
authors.forename: D Rohan
authors.initials: DR
authors.lastname: Jeyarajah
authors.affiliation: Emory University, Department of Surgery, Atlanta, GA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Beth Israel Deaconess Medical Center, Pancreas and Liver Institute, Boston, MA, USA.
authors.forename: A James
authors.initials: AJ
authors.lastname: Moser
authors.affiliation: Lewis Katz School of Medicine at Temple University, Department of Surgery, Philadelphia, PA, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: University of Michigan, Division of Minimally Invasive Surgery, Ann Arbor, MI, USA.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Varban
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.affiliation: University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Portland Providence Cancer Institute, Liver and Pancreas Surgery, Portland, OR, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Hansen
mesh_terms: D002983:Clinical Competence; D003226:Congresses as Topic; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D000070856:High Fidelity Simulation Training; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education* / Q000592:standards; D059032:Learning Curve; D010180:Pancreatectomy / Q000009:adverse effects / Q000193:education* / Q000592:standards; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000193:education* / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000193:education* / Q000592:standards; D066231:Surgeons / Q000193:education* / Q000592:standards; D016896:Treatment Outcome