first Board Examination June 2016, Amsterdam

Minimal Invasive SURGERY (MIS)
DEFINITION

Minimal Invasive Surgery (MIS) is a "transferable competency" which requires the acquisition of "Knowledge" in basic sciences required in the development of clinical and operative skills as well as specialised "Knowledge and Skills" in managing congenital and acquired diseases and injuries of most organ systems, which are treated by operative and other interventions.

The "transferable competency" MIS covers acute and nonacute diseases and injuries and acute and elective procedures in patients of all ages.

It provides for the operative and non-operative management, i.e. prevention, diagnosis, evaluation, decision making, treatment, intensive care and rehabilitation of patients with pathological processes that affect these organs including the management of pain.

It also involves the necessary knowledge and expertise leading to referral to specialised centers when this is indicated and possible, and where this is not possible because of time or geographical considerations, to possess the multi-specialty skills to carry out these interventions safely.

Minimal Invasive Surgery (MIS) cooperates with other surgical specialties, e.g. anesthesia, intensive care, emergency medicine, radiology, neurology, pediatrics, internal medicine, geriatrics, rehabilitation medicine, obstetrics and gynecology and pharmacy in the management of patients.

The surgeon must have acquired and must maintain specialised "Knowledge" and "Knowledge and Skills" (precisely defined in an additional catalogue) relating to the diagnosis, preoperative, operative and postoperative management in the following areas of primary responsibility:

  •         Abdominal wall and abdominal organs, including vascular, endocrine, congenital and oncological disorders
  •         Alimentary tract,
  •         Thoracic wall and organs,
  •         Minimal invasive surgery, especially laparoscopic and thoracoscopic procedures
  •         Head and neck
  •         Surgical oncology, including coordinated multidisciplinary management of the cancer patient,
  •         Diaphragmatic surgery, including diagnosis and surgery for hiatal hernia and reflux disorders
  •         Bariatric surgery, including diagnosis, indications and procedures
  •         Comprehensive management of trauma, especially to abdominal organs.
  •         Care of critically ill patients with underlying conditions including coordinated multidisciplinary management,
  •         Rigid and flexible endoscopy of alimentary tract, diagnostic and therapeutic,
  •         Methods for gastrointestinal function diagnosis, especially manometry, pH-metry and anorectal function diagnosis
  •         Diagnostic and interventional radiology and sonography.

The focus is on diagnosis and treatment. Diagnosis and treatment comprises all non-instrumental and instrumental techniques including flexible endoscopy, radiology, sonography, computer tomography and magnetic resonance imaging.

The MIS surgeon must be capable of employing endoscopic techniques both for diagnostic and therapeutic purposes and must have the opportunity to gain knowledge and experience of evolving technological methods.

The MIS surgeon must be also capable of interpreting all types of surgery-related radiological examinations.

The MIS surgical activity covers the pre-, peri- and postoperative period and follow-up of patients. The specialty also includes individual and general preventive activities, rehabilitation, palliation and management of pain, especially in oncologic patients.

The "transferable competency" MIS particularly focuses on managing diseases and injuries of the esophagus, stomach, intestines, rectum and pelvic floor, abdominal wall, biliary tract, liver, spleen and pancreas, thyroid gland, parathyroid gland, adrenal glands.

The "Knowledge" and "Knowledge and Skills" required by Minimal Invasive Surgery (MIS) are closely related to other specialities and MIS surgeons collaborate with all other surgical specialities and a variety of non-surgical specialties like e.g. anaesthesia, intensive care medicine, emergency medicine, radiology, neurology, paediatrics, internal medicine, geriatrics, rehabilitation medicine, urology and gynecology and obstetrics.

Minimal Invasive Surgery (MIS) is often performed in specialised centers, especially in oncological cases. When transferral is not possible because of time or geographical considerations, the MIS surgeon should possess the multi-specialty knowledge and skills to carry out these interventions safely.

Additionally, MIS surgeons are expected to have a knowledge of anatomy, physiology and biochemistry which enable them to understand the effects of common surgical disease and injuries upon the normal structure and function of the various systems of the body. They are expected to have a knowledge of cell biology which enable them to understand normal and disordered function of tissues and organs. They should have an understanding of the pathogenesis of the common correctable congenital abnormalities. They are expected to know the actions and toxic effects of drugs commonly used in perioperative and intraoperative care and in the management of critically ill surgical patients. They must also have an understanding of general pathology including the principles of immunology and microbiology in relation to surgical practice.

The MIS surgeon should have certified knowledge in basic technology of the used instruments, especially insufflation devices, monitors, cameras and light sources, ultrasound- and other energy-driven instruments and stapling and fixation devices.

The MIS surgeon must be trained in the economics of health care, in the assessment of research methods and scientific publications and be given the option of research in a clinical and relevant field of further training in another related specialty.

Georg Bischof
Foundation Chairman, Working Group of MIS

Wolfgang Feil
President of the European Board of Surgery