B. Physician Factors

1. Lack of Adequate Training

The minimally invasive surgical technique started in 1991-1992 with laparoscopic gallbladder removal. Since the success of that operation, more than 90% of the gallbladder is now removed via minimally invasive technique. A more structural training for general surgery resident was not available until very recently. In fact for more advanced laparoscopic surgery (i.e laparoscopic esophageal surgery, laparoscopic liver and pancreas surgery etc), many general surgery resident has undertake an extra 1 or 2 years of training or so called the “ fellowship”. During the fellowship, they are properly supervised and taught by the respective authority in the field.

Therefore, it is possible that some of the general surgeons may not have the exposure to the minimally invasive surgery to allow to them to gain experience. Certain general surgeons, however, do engage in active learning and has acquired the necessary skill to perform these operations.

2. Lack of data to support the outcome of minimally invasive surgery.

This statement could have been truth 4 or 5 years ago. Many excellent surgical centers who had engaged in clinical study have subsequently answered the safety questions. Studies showed not only this minimally invasive technique are safe but is in fact more beneficial to the patients (as mentioned in previous page).

Laparoscopic surgery or minimally invasive surgery is SAFE in experienced hand.

3. Do not have the time.

No doubt that laparoscopic operation can be very time consuming, especially when they are at their learning curve. An open colectomy that usually take 1 to 2 hours to perform can takes up to 3 to 4 hours to perform. Despite the longer operating time, the recovery time for patient after the operation is certain much shorter and the risk of post operative complications is equally lowered as well