Two major controversial issues dominate minimally invasive surgery (MIS) training: who should be trained and how should we train them? Although we focus on these two issues, it will become apparent that they are interconnected and that a large number of smaller issues are nested within each of them. We suggest that these issues reveal that the surgical training system is not working; nor is it currently taking a path that will lead to its healthy rebuilding. MIS, compared to its open surgery (OS) counterpart, has generally been shown to reduce patient hospital-stays and complications, to speed patient recovery, return patients to work more quickly, and to improve cosmesis. Historically, the public demand for MIS procedures has caused surgical centers to increasingly offer this approach to their patient population. This patient demand has also challenged medical centers ability to provide service the number of trained laparoscopic surgeons has often been insufficient to meet the demand for surgery. Along with the supply-demand gap is a history of complications associated with early experience with different procedures. Thus the birth of a unique surgical methodology began in controversy, which continues today with training issues.
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