Credentialing, privileging, proctoring in the era of laparoscopic surgery, history of credentialing problems...

Laparoscopic surgery in the United States was revolutionized in 1989. Even though Semm had popularized laparoscopic surgery in the early nineteen eighties in Germany, it was the advent of Laparoscopic Cholecystectomy in 1989 that triggered the explosive training and eredentialing issues in laparoscopic surgery. In a letter to the editor of the American Journal of Surgery, in June 1990, the author had recommended the following for training courses: 1) the operators should have extensive hands-on experience in diagnostic laparoscopy prior to embarking on laparoscopic surgery; 2) hands-on training to develop hand-eye coordination using Berci-Sackier trainers; 3) extensive explanation on the use and abuse of video laparoscope and accessory instrumentation; 4) a minimum experience as prime operator in at least 3 pigs, each weighing 90-100 lbs., with experience as an assistant operator and camera operator in 6 more pigs, making a total of 9 pigs per participant. This letter was written with an intent that proper training of surgeons would take place. We advocated a surgeon/co-surgeon team approach, to avoid adverse outcomes. In those days, weekend courses proliferated and surgeons came back and started doing procedures with minimal experience. This explosive growth was driven by patient demands for this procedure. As anticipated, untoward outcomes were reported.