Minimal Invasive Surgery (MIS)

The Minimal Invasive Surgery (MIS) syllabus comprehensively describes "Knowledge" and "Knowledge and Skills" (= basis for an individual "Log-book") mandatory for the qualification as F.E.B.S./MIS.

The syllabus is at this time not a complete curriculum that gives a structured educational plan but provides a crude orientation and a framework around which preparation for the qualification as F.E.B.S./MIS can be structured.

The syllabus should not be viewed as static but will be continuously revised and updated by the members of the committee. It is noted, that research and changes in medicine may lead to significant changes in theory and clinical practice and by that will influence the content of the syllabus. New topics will be introduced and obsolete topics may be deleted. The candidates are expected to update their level according to the recent surgical practice and scientific literature.

To achieve the qualification as F.E.B.S./MIS "Knowledge" have to be documented and provided for Eligibility and are assessed by Examination.

"Knowledge and Skills" have to be documented and proved in the log-book for Eligibility and may be additionally assessed by examination. For pragmatical reasons the individual log-books are scrutinized in the Eligibility process taking into consideration the various national requirements and local situations.

By that provisional arrangements are provided: if e.g. "flexible endoscopy" is not part of MIS in a distinct country, the candidate may omit this section in "Knowledge and Skills" without consequences for the Eligibility process, but approval of "Knowledge" in e.g. "flexible endoscopy" will be mandatory for the Examination. This procedure is also valid for e.g. "bariatric surgery" or "pancreatic surgery" and others.

The MIS surgeon is an expert in performing various surgical interventions in the abdominal and thoracic cavity through minimal access. Due to the wide range of indications and procedures encompassed in this field, it is essential for the MIS specialist to undergo continuing medical education and technological training. Besides preoperative work-up and selection of patients the successful MIS procedure strongly depends on safely and optimally placed entry trocars to access the operative field.

In the major field of hernia surgery it is important to have knowledge in mesh types and structures as well as fixation devices.

Gallbladder removal in chronic and acute stages is a domain of MIS and should be safely achieved in >90% of unselected cases. Intraoperative access to radiologic examinations (cholangiography) or other imaging modalities such as laparoscopic ultrasound must be provided by the surgical team also in the acute situation.

The MIS surgeon and the team have to be trained in managing intraoperative bleeding situations and in rapid conversions to open surgery. Basic training facilities (black box, pelvi-trainer) have to be accessible in spezialized MIS units/departments.

Videodocumentation of MIS procedures is an essential prerequisite for training, certification and quality control in surgical units performing MIS operations.

(Video) Endoscopy is another integral part of planning and performing laparoscopic/thoracoscopic interventions, increasingly more often done synchronously as combined access procedures.

Eligibility for "MIS centers" is ususally defined by national surgical societies referring to number of procedures/endoscopies per year, number of specialized surgeons, adequate documentation, education and quality control.

If malignant diseases are treated by MIS it is essential for the MIS surgeon to cooperate with a multi-disciplinal team ("Onco-Board") in order to guarantee optimal oncological outcome.


The specialty of Minimal Invasive Surgery requires documented and assessed knowledge in:

Preoperative Management

  • Physical examination
  • Exact information on previous operations including mesh or other implants
  • Tests of respiratory, cardiac, renal and endocrine function
  • Patient information and documentation of informed consent (including risks of technique)
  • Information about principles of ERAS
  • Prophylaxis of thromboembolic disease
  • Assessment of fitness for anaesthesia and surgery
  • Premedication and sedation

Intraoperative Care

  • Patient positioning (including extreme anti-Trendelenburg and other positions)
  • Prevention of nerve and other injuries in the anaesthetised patient
  • Principles of general and regional anaesthesia (including optimal fluid management)

Postoperative Management

  • Pain control
  • Post-operative monitoring
  • Post-operative complications
  • Prevention, recognition and management of complications
  • Early recognition and management of sepsis
  • Respiratory failure-recognition and treatment
  • Nutritional support-indications, techniques, total parenteral nutrition

Basic Minimal Invasive Surgical Technique and Technology

  • Patients' positioning
  • Surgical instruments and technical OR equipment for open access
  • Instruments and technical equipment for MIS (especially cameras, light sources, insufflators, energy devices)
  • Patient selection and indications for MIS
  • Techniques of establishing access for MIS (e.g. laparoscopy, SILS, NOTES, thoracoscopy)
  • Detection and treatment of MIS complications
  • Trocar positions, placement and closure techniques
  • Basic ergonomics in MIS (table and monitor position)
  • Suturing and stapling in MIS
  • Mechanical stapling devices and techniques of stapled anastomoses
  • Surgical meshes
  • Diathermy-principles and precautions and principles of energy sources
  • Explosion hazards relating to general anaesthesia and endoscopic surgery
  • Diagnostic Laparoscopy (including biopsy of peritoneal pathologies)
  • Thoracoscopy (including biopsy and drainage)


  • The role of surgery in the treatment of cardiac, lung and oesophageal disease
  • Thoracocentesis, chest drainage
  • Techniques of thoracotomy
  • thoracoscopy
  • Empyema thoracis
  • Pneumothorax
  • Pneumothorax
  • Hemothorax
  • Pleural effusion/empyema
  • Focal hyperhidrosis
  • Chest tube placement
  • Thoracoscopy with or without biopsy
  • Thoracoscopic pleurodesis
  • Sympathetic nerve surgery
  • Thoracoscopic lung wedge resection

Abdomen - General

  • Acute abdominal pain
  • Intra-abdominal abscess
  • Mesenteric cyst and lymphadenitis
  • appendicitis
  • Tubo-ovarian pathologies
  • Chronic abdominal pain
  • Carcinomatosis
  • Spontaneous bacterial peritonitis
  • Desmoid tumors
  • Chylous ascites
  • Retroperitoneal fibrosis
  • Laparoscopic exploration (diagnostic laparoscopy) and biopsy taking
  • laparoscopic drainage of abdominal abscess
  • Laparoscopic retroperitoneal lymph node dissection

Abdominal Wall and Alimentary Tract

The surgical anatomy of the abdomen and its viscera and the applied physiology of the alimentary system, relevant to clinical examination, to the interpretation of special investigations, to the understanding of disorders of function and to the treatment of abdominal disease.

  • Principles of standard and tension-free hernia repair
  • Principles of hernia repair with/without surgical meshes
  • Inguinal hernia
  • Femoral hernia
  • Ventral hernia
  • Incisional hernia
  • Miscellaneous hernias
  • Transperitoneal and total extraperitoneal repair of inguinal and femoral hernia
  • laparoscopic repair of ventral/incisional hernia
  • Repair of miscellaneous hernias
  • Component separation and abdominal wall reconstruction

Biliary Tract

  • Cholecystitis
  • Gallbladder stones
  • Cancer of the bile ducts
  • Gallstone ileus
  • Iatrogenic bile duct injury
  • Biliary pancreatitis
  • laparoscopic cholecystectomy
  • intraop imaging of biliary tree
  • Laparoscopic common bile duct exploration
  • Laparoscopic and open revisional surgery (e.g for bile leak, bleeding)


  • Liver mass − evaluation
  • Hepatic abscess
  • Hepatic adenoma
  • Focal nodular hyperplasia
  • Hemangioma
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Metastatic tumors
  • Benign Liver cysts
  • Laparoscopic liver biopsy
  • Laparoscopic unroofing of liver cyst
  • Drainage of liver abscess
  • Laparoscopic segmentectomy/lobectomy (in specialized centers)
  • Intraoperative ultrasound of liver (in specialized centers)


The surgical anatomy, applied physiology and pathology of the endocrine glands relevant to clinical examination, to the interpretation of special investigations, to the understanding of disordered function and to the principles of surgical treatment of common endocrine disorders.

  • Incidental adrenal mass
  • Pheochromocytoma
  • Primary hyperaldosteronism
  • Cushing’s syndrome
  • Cushing’s disease
  • Adrenocortical carcinoma
  • laparoscopic adrenalectomy

Metabolic and Bariatric Surgery

  • Principles of metabolic and bariatric surgery
  • Patient selction and indication for bariatric surgery
  • Surgical techniques in bariatric surgery
  • Detection and treatment of complications
  • Role of multidisciplinary management of morbidly obese patients
  • laparoscopic gastric banding
  • sleeve gastrectomy
  • gastric bypass
  • others


  • Pancreatic abscess and infected necrosis following severe pancreatitis
  • Pancreatic pseudocyst
  • Cystic neoplasms
  • Intraductal papillary mucinous neoplasms
  • Gastrinoma and Zollinger-Ellison syndrome
  • Insulinoma, VIPoma, Glucagonoma and Somatostatinoma
  • Nonfunctional endocrine tumors
  • Lymphoma of pancreas
  • Laparoscopic/endoscopic pancreatic debridement for necrosis
  • Distal pancreatectomy
  • Intraoperative pancreatic ultrasound
  • Drainage pancreatic pseudocyst


  • Hemolytic anemias
  • Idiopathic thrombocytopenic purpura
  • Secondary hypersplenism and splenomegaly
  • Neoplasms of spleen
  • Splenic cysts and infarction
  • laparoscopic splenectomy
  • Partial splenectomy/splenorrhaphy


  • Zenker’s diverticulum
  • Epiphrenic diverticulum
  • Hiatal hernia
  • Gastroesophageal reflux and Barrett’s esophagus
  • Dysphagia
  • Schatzki’s ring
  • Achalasia
  • Nutcracker esophagus
  • Spontaneous esophageal perforation
  • Iatrogenic esophageal perforation
  • Scleroderma connective tissue disorders
  • Benign neoplasms
  • Adenocarcinoma
  • Squamous cell carcinoma

  • Diagnosis of gastroesophageal reflux (e.g. pH-metry)
  • Diagnosis of esophageal and gastric motility disorders (e.g. manometry)
  • laparoscopic antireflux procedure
  • laparoscopic repair of paraesophageal hernia
  • Repair/resection of perforated esophagus
  • Total esophagectomy (in specialized centers)
  • Esophagogastrectomy (in specialized centers)
  • Enoral stapling-myotomy of Zenker’s diverticulum
  • Laparoscopic Heller myotomy
  • Collis gastroplasty


  • Upside down stomach
  • Upper gastrointestinal bleeding
  • Gastric carcinoma
  • Duodenal ulcer
  • Gastric ulcer
  • Peptic ulcer disease with bleeding, perforation or obstruction
  • Gastric polyps
  • Gastric lymphoma
  • Gastric carcinoid tumor
  • Morbid obesity
  • laparoscopic gastric resection
  • Repair of  duodenal perforation
  • Diagnostic and therapeutic upper GI endoscopy
  • Truncal and selective proximal vagotomy
  • Pyloroplasty

Jejunum & Ileum

  • Small bowel obstruction and ileus
  • management of Crohn’s disease of small intestine
  • Meckel’s diverticulum
  • Small intestinal polyps
  • Small intestinal adenocarcinoma
  • Small intestinal lymphoma
  • Small intestinal carcinoid tumor
  • Small intestinal GISTs
  • laparoscopic small bowel resection
  • laparoscopic adhesiolysis
  • laparoscopic feeding jejunostomy
  • Resection and stricturoplasty for Crohn’s disease

Colon & Rectum

  • Acute and chronic appendicitis
  • Diverticulitis
  • Colonic polyps
  • Colonic and rectal cancer
  • Miscellaneous colonic neoplasms
  • Appendiceal neoplasms
  • Crohn's disease
  • Ulcerative colitis
  • Endometriosis
  • Functional constipation
  • Rectal prolapse and intussusception

  • laparoscopic appendectomy
  • laparoscopic colon and rectum resection
  • TransAnal MIS
  • anastomosis (extra- and intracorporeal)
  • diverting colostomy and stoma formation
  • laparoscopic (resection) rectopexy (suture, mesh)


  • Rectal polyps/neoplasms
  • Rectal prolapse
  • Fecal incontinence and fecal outlet obstruction
  • Transanal endoscopic microsurgery (TEM) and transanal MIS
  • laparoscopic transabdominal operation for rectal prolapse

Flexible Endoscopy

  • Handling of endoscopes and hygienic measures
  • Flexible diagnostic esophago-gastroduodenoscopy
  • Rigid and flexible diagnostic procto-colonoscopy
  • Therapeutic endoscopy for bleeding (injection, clip application, heated probe)
  • Interventional endoscopy (e.g. stenting, dilatation, polypectomy, mucosectomy)

Evaluation & Quality Control

  • Decision-making in surgery
  • Clinical audit
  • Statistics and computing in surgery
  • Documentation
  • Principles of research and design and analysis of clinical trials
  • Critical evaluation of innovations-technical and pharmaceutical
  • Principles and pharmacology of intravenous drug delivery
  • Quality control and quality management
  • CIRS (Critical Incident Reporting System)
  • Implementation of clinical studies
  • Legal aspects
  • Communication with patients, relatives and colleagues
  • Team working, leadership
  • Situational awareness, stress and fatigue

Georg Bischof
Foundation Chairman, Working Group of MIS

Wolfgang Feil
President of the European Board of Surgery