For the Record…

| January 14, 2008

For the former members of the ASBS, the name change to ASMBS is just another consonant. For the rest of the world, it may be an epiphany…

Dear Bariatric Times Editor:

“…that which we call a rose by any other name would smell as sweet.”

The American Society for Metabolic and Bariatric Surgery. For those of us who have experienced the changes in our specialty and the important role the ASBS has played in that evolution, it has been difficult to include that extra consonant M. AS..M..BS. How did this change come about?

Much credit must go to Dr. Walter Pories, past president of the ASBS, who first proposed this concept years ago. As an organization, we were not ready to embrace this radical idea then, but maturity and time have allowed us to realize the wisdom of this proposal that was later championed by Phil Schauer, recent past president of the ASBS. Many of us did not want to disrespect the grandfathers of our society by changing their name for our society that was incorporated in 1983, but we found ourselves listening in amazement as the majority endorsed the idea at our latest business meeting in San Diego. The vote was nearly unanimous for the ASMBS. But what does the M really stand for?
met•a•bol•ic [met-uh-bol-ik] – adjective
1. of, pertaining to, or affected by metabolism.
2. undergoing metamorphosis.
[Origin: 1735–45; < Gk metabolikós changeable, equiv. to
metabol() (see metabolism) + -ikos -ic]

The problem has been and continues to be not who we are, but what the public, insurance industry, and our colleagues perceive us to be. Despite documented control or improvement in diabetes, hypertension, obstructive sleep apnea, and hyperlipidemia 75 to 87 percent of the time, as well as improvement in quality and longevity of life and reduction in the incidence in cancer, the majority of patients are denied access to our lifesaving therapy. Even more tragic is that there is no alternative to surgery that comes anywhere close to our effectiveness, efficiency, and safety. No one gets it.

So, what’s in a name? Does the ASMBS still stand for education, integrity, collaboration, and patient advocacy? You bet it does. For the former members of the ASBS, the name change to ASMBS is just another consonant. For the rest of the world, it may be an epiphany.

Best regards,

Kelvin Higa, MD, FACS
Clinical Professor in Surgery, UCSF-FRESNO
Director, Bariatric and Minimally Invasive Surgery,
Fresno Heart Hospital, Fresno, California
President, American Society for Metabolic and Bariatric Surgery

~~~~~

Training a New Generation of Bariatric Surgeons Using Virtual Reality…

Dear Bariatric Times Editor:
Amid the alarming rise in obesity rates in the US, we have seen the number of bariatric operations increase exponentially over the past decade, with Roux-en-Y gastric (RYGB) bypass being the most common procedure. RYGB is a very complex operation and traditionally requires a large, open incision in the abdomen. The open procedure greatly increases the risk of wound infection and lengthens recovery time. To decrease those risks, bariatric surgeons are increasingly turning to the minimally invasive laparoscopic gastric bypass procedure.

Randomized trials have shown significant benefits of the laparoscopic operation; however, laparoscopic gastric bypass is a technically challenging procedure and can be associated with a steep learning curve. Laparoscopic gastric bypass requires a set of specialized tools and skills that can only be perfected with practice. Studies have shown that complications occur more frequently during the surgeon’s early experience with the laparoscopic procedure.

In the past, surgeons could learn to perform complex abdominal operations through through cadaver or animal laboratory training or by observing or assisting experienced surgeons. Each of these methods has its own limitations. Cadaver training is expensive and does not replicate the operative environment as the tissue has been chemically altered. Animal training lacks the realism of actual human anatomy. Clinical operative observation of live surgery or assisting with an experienced surgeon is beneficial as it introduces the novice surgeon to the multidimensional tasks of surgery, but is limited by the lack of hands-on practice. Upon completion of a short course on the technique of laparoscopic gastric bypass, most surgeons proceed to learn laparoscopic gastric bypass with their patients. This process represents the learning curve, which does not allow the surgeon any margin for error from which to learn and improve skills.

Similar to the rigorous training of airline pilots, the ideal solution for training of surgeons with laparoscopic gastric bypass is to create a model that replicates the realistic operative environment that enables the surgeon to perform the same operation repeatedly. This model will allow the surgeon to learn from his or her errors and sharpen operative skills without placing the patient at unnecessary risk. The need for a realistic gastric bypass skill training module has resulted in the development of several types of skill training units. Most of these, however, are crude devices. They do not provide a realistic simulation of the operative environment, nor do they prepare the surgeon for the full range of problems and contingencies that may arise when the surgeon operates on patients.

The new era of surgical simulation now allows the surgeon to hone his skills before attempting to operate on a live patient. Simulators add a layer of safety for the patients as the surgeon may improve his of her skills prior to the actual procedure. Currently, only one company produces a virtual reality simulator for the laparoscopic RYGB procedure (LAP MentorTM, SimbionixTM, Cleveland, OH). The LAP MentorTM is an advanced virtual reality minimally invasive surgical simulator that recently added a laparoscopic gastric bypass module (Figure 1). This module provides real-life visual and tactile simulation of the key stages of the gastric bypass procedure and allows the surgeon to perform all of the essential steps of this complex operation, from the initial construction of a gastric pouch to performance of a small bowel anastomosis and gastrojejunostomy. By recording the surgeon’s performance, the simulator can provide specific feedback and allow him or her to perform the laparoscopic gastric bypass as many times as necessary to bring his or her skills to the desired level without placing the patient at risk.

Surgical simulation in bariatric surgery provides a new frontier on the way we train bariatric surgeons. It allows residents, fellows, and experienced surgeons the most efficient learning experience while minimizing the risks to the patient.

Best regards,

Ninh T. Nguyen, MD

Address for Correspondence:
Ninh T. Nguyen, MD, Dept. of Surgery, 333 City Bldg. West,
Ste. 850, Orange, CA 92868. E-mail: ninhn@uci.edu;
Phone: (714) 456-8598

Category: For the Record

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