SAGES

Reimagining surgical care for a healthier world

SAGES Launches iLAP Mastery and Education Program to Improve Global Surgical Outcomes Courses to Commence in 9 Centers in Mexico

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Having access to minimally invasive surgery (MIS), where patients can return to work the same day or in just a few days, is of tremendous advantage to patients globally, especially when a patient is the primary income earner for his or her family. To address disparities in global access to MIS, the SAGES Go Global Program promotes the worldwide adoption of MIS through education, research, innovation and training. Through its new iLAP initiative, SAGES partners with international societies and offers instruction on how to build and run a curriculum so surgeons can replicate what they learn and help spread the knowledge and skills required to perform common MIS procedures.
“We are thrilled to partner with the Association Mexicana de Cirugia General on this initiative which will help make tremendous strides in public health for Mexico,” said Dr. Jeffrey Hazey, SAGES Go Global Chair. Dr. Hazey and a team of SAGES surgeons presented the iLAP program to the Asociacion Mexicana de Cirugia General (AMCG) in Mexico City at Senator Fernando Mayans Canabal’s Safe Chole Forum on April 19, 2017. Initial courses, focusing on teaching safe cholecystectomy, or safe and minimally invasive gallbladder surgery, will take place in 9 different centers in Mexico where a need for uniform surgical standards has been perceived. iLAP will track and measure both pre-course and post-course outcomes, using the SIGMA surgical platform, in order to inform future efforts.
“One of the main problems we face when taking care of surgical patients outside the main cities in our country, is the lack of well-prepared surgeons proficient in minimally invasive surgical techniques,” said Senator Fernando Mayans Canabal, M.D. and President of the Social Security Commission. “We estimate that only around 18% of general surgery procedures in Mexico are undertaken laparoscopically and we need to adopt a culture of safety in minimally invasive surgery since our rate of surgical complications in small hospitals within the country is unacceptable,” added the Senator.
“We cannot thank SAGES Go Global and the iLAP team enough for the devotion, tireless efforts and camaraderie they have shown in support for our program,” said Eduardo Moreno Paquetin, M.D. and 2nd Vice President of the Mexican College, AMCG. “They are true friends and we have no doubt that thanks to the joint effort we will make a difference in the way minimally invasive surgery is practiced in our country to the benefit of Mexican patients.”The first 2 of 9 planned iLAP courses will take place this summer in Guadalajara and Mexico City.
Over 750,000 cholecystectomies are performed each year in the United States alone and patients benefit from reduced pain, faster return to normal activities, and reduced risk of surgical site infection with a laparoscopic approach compared to an open operation. However, bile duct injury rates have increased since the introduction of laparoscopic cholecystectomy, occurring in about 3 per 1,000 procedures performed, thus increased training on safe chole practices is critical to improving outcomes. Through iLAP, SAGES is committed to improving safe chole outcomes internationally.
SAGES Go Global: Leveraging Laparoscopy and Endoscopy to Change Global Health
The mission of SAGES Go Global is to promote global collaboration and exchange of knowledge to optimize patient care. Through its webcasting and new iLAP Program, SAGES operates on an international level providing surgical educational worldwide to improve health care in low resource regions. Since its founding, SAGES Go Global has held over 27 International Proctoring Courses. Collectively these sites have performed over 6,000 basic laparoscopic cases making the majority of the sites not only self-sustainable but a model for duplicating training efforts that expand across each country. An annual webcast from the SAGES Congress is broadcast to more than 67 countries internationally in areas such as Peru, the Philippines, and Tanzania and into remote locations in Iraq and Afghanistan and has engaged over 3,000 surgeons worldwide, including the U.S. Military and Royal Military.
Learn more about SAGES Global Affairs programs at

High School Students Try on Their Surgical Gloves at SAGES Mini Medical School

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Boot Camp and Interactive Experience Sparks Interest Among Students Wanting to Join the Future Ranks of Minimally Invasive Surgery

What:  The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)  Mini Medical School Boot Camp and Interactive Experience where 100 high school students from the Houston area will learn about the field of surgery through lecture and simulation so they can begin to appreciate that being in the operating room is rewarding, important and exciting work. The program includes hands-on surgical skill development training lap and the “Top Gun Interactive Experience” – a power packed hour featuring video games that help decrease errors, to robotic helicopters that allow students to show off their skills.

When & Where: Saturday, March 25th, ROOM 332B at the George Brown Convention Center as part of the SAGES annual meeting. 

Who:

  • Houston Area High School Students
  • James Butch Rosser, Mini-Med School Session Chair, general surgeon at Florida Hospital Celebration Health
  • Vadim Sherman, Mini-Med School Session Co-Chair, Assistant Professor at Weill Cornell Medical College in Houston, TX

Visuals: Students learning about surgery via hands-on exercises involving surgical tools, video games, robotic helicopters and more.

For more information about the SAGES Mini Medical School Boot Camp and Interactive Experience, visit https://www.sages2017.org/mini-med-school

About SAGES

The mission of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is to improve quality patient care through education, research, innovation and leadership, principally in gastrointestinal and endoscopic surgery. SAGES is a leading surgical society, representing a worldwide community of over 6,000 surgeons that can bring minimal access surgery, endoscopy and emerging techniques to patients worldwide. The organization sets the clinical and educational guidelines on standards of practice in various procedures, critical to enhancing patient safety and health.

The Surgery of Tomorrow is Here Today

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Social Media, Virtual Reality, Telementoring and the Changing the Face Surgery

At the SAGES 2017 Meeting, March 22nd– 25th in Houston, TX

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) continues to strive to improve quality patient care in minimally invasive surgery (MIS).  The Society’s annual meeting this March will highlight how social media, virtual reality simulation and telementoring have enhanced both patient and physician experience. These modern technologies and other medical advancements in the field of MIS have helped to make procedures less painful and substantially improve the patient experience after surgery  in a variety of conditions. “SAGES is Home: Collaborate, Communicate, Connect” will be held March 22-25 at the George R. Brown Convention Center in Houston.

Social media platforms are now venues widely used by surgeons to stay up-to-date on current literature and to discuss diagnostic dilemmas. SAGES Board Member and Founder of the International Hernia Collaboration (IHC) Dr. Brian Jacob will present a keynote lecture on “Social Media and Health Care” at the meeting. In an effort to help optimize patient outcomes after hernia repair, in 2012 Dr. Jacob launched the IHC, a private Facebook™ group that has now grown to over 2500 hernia surgeons and hernia industry partners. He believes there is significant power in large focused professional networks like the IHC, and expects that they should continue to grow. , Based on this novel and successful initiative, SAGES has contributed to start other similar groups which most likely will rapidly change the way medical information is disseminated and exchanged,  thus improving  the care we bring to our patients.

Through telementoring, doctors across the country are able to train other surgeons and collaborate with each other from a distance. This improves proficiency  in minimally invasive surgery and patient care overall. SAGEShas been at the forefront of establishing best practices in telementoring and strategizing recommendations for future directions in this field.  The aim is to accelerate the rate at which minimal invasive surgery is adopted and will be available to patients. “Coaching and Telementoring in the Global Arena,” chaired by SAGES Board Member Dr. Allen Okrainec at the SAGES meeting, will cover technical logistics, real life practices, and emerging technologies that utilize telementoring for training, mentoring and coaching.

Simulation and the use of virtual reality technology has heightened the quality of training opportunities for surgeons,while also resulting in improved outcomes.  For example, this past year, passing the SAGES Fundamentals of Endoscopic Surgery exam – which includes virtual reality simulation to help measure a surgeon’s skill level – became a requirement for graduating surgical residents. Additional SAGES 2017 meeting highlights showcasing the impact of virtual reality, telementoring, social media and other technological innovation will include:

 Wednesday March 22, 2017

  • The Impact of Social Media on Adoption of Robotic Hernia Repair – Brian Jacob, MD, 11:00AM in Ballroom A/B
  • Simulation Based Mastery Learning for Endoscopy – Matthew Ritter, MD, 3:10 PM in Room 320
  • Symposium: Coaching and Telementoring in the Global Arena – Chair: Allan E. Okrainec, MD, 3:30 PM – 5:00 PM in Room 320

Thursday, March 23, 2017:

  • Keynote “Why It Pays To Be Likeable” – Speaker: Dave Kerpen, #1 LinkedIn Influencer, 9:00 AM – 9:45 AM in Ballroom A/B
  • Keynote “Social Media and Health Care” – Speaker: Brian P. Jacob, MD, 9:45 AM – 10:15 AM in Ballroom A/B
  • SAGES Stories: Controversies in Foregut Surgery – Honest Discussions from Expert Surgeons: Chair: Brian Dunkin, MD | Co-Chair: Steven Schwaitzberg, MD | | This unique session will have world leaders in the management of foregut disease present real clinical controversies TED style. Each speaker will share patient stories to explore the management of debated foregut issues such as POEM versus Heller for achalasia and paraesophageal hernia repair in the elderly. Following each presentation, the audience will have the opportunity to interact with the presenters and moderators in a relaxed atmosphere to explore each topic in greater detail. 1:30 PM – 3:30 PM in Room 342
  • Symposium: International Hernia Collaboration Symposium – Chair: Igor Belyansky, MD, 3:30 PM – 5:30 in Room 342

Friday, March 24, 2017:

  • Keynote “Presidential Address” – Speaker: Daniel J. Scott, 8:30 AM – 9:15 am in Ballroom B
  • Panel: Robotic Surgery – New Platforms and Strategies to Overcome the Learning Curve – This session will focus on simulation, augmented virtual reality, procedure specific modules and team training. Chair: Omar Yusef Kudsi, MD, MBA, 4:30 PM – 5:30 PM in Room 320
  • Impact of Social Media on the Robotic Learning Curve (24/7) – Adrian P. Martin, MD, 4:40 PM in Ballroom A/B
  • SS26 Education Technology, Teaching and Learning -This session will focus on the role of YouTube in surgical education, telementoring and the SAGES Foregut Surgery Collaboration as a social media resource for surgeons. Moderator: Santiago Horgan, MD, 4:30 PM – 5:30 PM Room 322

Saturday, March 25, 2017:

  • SAGES Mini Medical School – In this session, 100 high school students from the Houston area will learn about the field of surgery through lecture and video-game simulation. Chair: James Rosser Jr. MD, 7:30 AM to 2:00 PM in Room 322B
  • Shark Tank: SAGES/AGA Joint Session – This forum is geared toward innovators and companies interested in pitching and improving novel concepts, non-FDA approved devices, and new non-marketing indications. Chair: Jeffrey Marks, MD, 8:00AM to 9:30AM in Room 322
  • Emerging Technology Session– This session features the latest and newest techniques and technologies in gastrointestinal and endoscopic surgery. Abstracts submitted by physicians, industry engineers, scientists and researchers are carefully selected to showcase cutting-edge new research and emerging technologies. Many revolutionary surgical innovations were first introduced at this session. Chair: Kevin Wasco, MD, 9:30 -11:30 in Room 322

For more information about the 2017 meeting visit www.sages2017.org or download the SAGES 2017 Meeting App from the Apple App Store, the Google Play Store or as a native Kindle Fire App.

SAGES ADOPT Program

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Acquisition of Data for Outcomes and Procedure Transfer

Brian J. DunkinBy Brian Dunkin, MD, SAGES Past President

When was the last time you learned a completely new procedure and brought it to the operating room for the first time? How did you do it? Read a book? Watched a video? Attended a course? Worked with a colleague? Chances are, it was a combination of all of these things. And, you had to do it on your own.

Isn’t it amazing that in these modern times of rapid change in surgery there is no real infrastructure to help practicing surgeons learn new techniques and safely adopt them into practice? SAGES is working to change that.

One of the SAGES programs that is changing how practicing surgeons learn new operations is called ADOPT (Acquisition of Data for Outcomes and Procedure Transfer). This innovative program transforms the usual hands-on post-graduate course conducted during the SAGES annual meetings into a gateway to a one-year longitudinal curriculum that is improving successful procedural adoption.

ADOPT is the brainchild of the Continuing Education Committee, currently led by Drs. John Paige, Elisabeth McLemore, Vanessa Palter, and Jonathan Dort as well as myself. It was first introduced at the 2015 annual meeting with a focus on abdominal wall reconstruction and a second round of training was again offered in 2016.

The ADOPT pathway begins by ensuring that the expert faculty who are going to be instructors for the program are also excellent teachers. Each ADOPT expert must attend a special train-the-trainers (TT) course to prepare them to be good surgical coaches.

Next, mentees who enroll in the program must complete a pre-course survey to understand their practice better and what they hope to gain from the course (See Figure Below). Then, during the annual meeting mentees participate in a hands-on training program with their expert mentors. During the training, mentees are asked about their specific goals and the course experience is modified to meet them. By the end of the day, the experts have come to understand each trainee’s needs and skills and assigned them a personal take-home message to work on before their first case.

As the year progresses, there are multiple touch points for mentors and mentees to connect in order to help the mentees navigate through the early part of their learning curve. These touch points include webinars, video review of actual procedures, and a face-to-face meeting at the American College of Surgeons annual meeting. The International Hernia Collaborative Facebook page was also used to foster immediate from an expert on-line community to provide input on challenges faced in adopting new procedures and managing difficult patients. In addition, mentees complete 3 and 6 month surveys about their performance of abdominal wall reconstruction. The whole program concludes with a presentation of results at the next SAGES annual meeting.

ADOPT is not only providing a better training curriculum, it is also creating a community where expert and less experienced surgeons can come together to foster successful procedural adoption. The results so far have been impressive. In December 2016 Jonathan Dort et al. published the results of the ADOPT program in Surgical Endoscopy (DOI 10.1007/s00464-016-5366-z published on-line December 2016).

To quote: “Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence in employing a components separation via an open approach (p = 0.051).”

Following on the success of the ADOPT program to teach practicing surgeons advanced techniques in abdominal wall reconstruction, the same methodology is being applied to teach laparoscopic colectomy at the SAGES 2017 Annual Meeting in Houston, Texas. Led by Drs. Jaime Sanchez and Peter Marcello, the ADOPT colectomy program will guide practicing surgeons to adopt laparoscopic right and left colectomy into their practice.
With programs like SAGES ADOPT, no longer are annual meeting post-graduate courses a single event that is unlikely to lead to successful procedural adoption. Now, these courses are the entryway into a 12 month longitudinal training program conducted by expert coaches. So stop relying on YouTube, out-of-date text books, and cryptic articles to learn a new procedure.

Sign-up for ADOPT and join a community of surgeons like yourself receiving expert guidance from mentors who have taken the time to learn how to be effective coaches.

Click https://www.sages.org/wp-content/uploads/2013/09/SCOPE-2017-winter.pdf to return to SCOPE Winter 2017.

SAGES Go Global

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By Linda P. Zhang, MD

Over the last ten years, there has been increasing attention paid to the need for global surgery and training of surgeons in developing countries. There have been a variety of service-oriented programs, ranging from short-term surgical trips, to long-term capacity-building collaborations between U.S. based hospitals and local hospitals.

As someone who has been interested in global health, I have participated in many of these types of global health volunteerism. In college and medical school, equipped with my idealism and my eagerness to make a difference, I joined in health service trips to Ghana, Honduras, India, Dominican Republic, and Haiti. Each of these trips gave me insight in the health disparity among nations, and fueled my desire to further pursue global health/surgery. However, as the novelty of a new country and new faces wore thin, I began to feel that I was not contributing as much as I was personally gaining from these experiences. Despite assisting in repairing 80 hernia in one week, I was not making a lasting impact for the local population. My focus began to switch toward capacity-building projects and training of local surgeons.

In joining SAGES, I was astounded by the number of sustainable international projects that are supported and funded by SAGES. These projects aim to enable local surgeons to improve their skills and bring advanced technology to their patients. Many have argued that it is too challenging to bring high-tech equipment, like laparoscopy, to an underdeveloped country. Dr. Raymond Price, with support from SAGES, defied that misconception. His training courses in Mongolia allowed local surgeons to not only be self-sustainable in performing laparoscopy, but these courses also became a model for duplications and expansion across Mongolia.

Local Mongolian surgeons have now performed over 4,000 basic laparoscopic cases. His project has fundamentally changed how surgery is practiced in Mongolia. The Haiti Telementoring Lecture Series, also a SAGES sponsored project, has connected expert U.S. surgeons with Haiti surgical residents. It helps to fill the gap in surgical education left behind by the earthquake 7 years ago. In addition, SAGES’s Go Global has launched the Academic Exchange program in 2014, allowing Chinese surgeons the opportunity to do an observership in an institution in the U.S.

These are just a few highlights of what SAGES has achieved in global surgery. As for myself, under the guidance and support of my department chair at Mount Sinai, Dr. Michael Marin, I began by redesigning our general surgery resident rotation to the Dominican Republic. Each year, every PGY-3 rotate to the DR for one month in a large public hospital in Santiago, DR. This life-changing experience gives young surgeons the opportunity to gain valuable skills assisting in the diagnosis and treatment of patients in a resource limited environment. In return, our residents are building capacity by bringing down FLS training boxes and designing a curriculum for local residents to improve their laparoscopic skills. In addition, our residents are involving local surgical residents in year-long research projects. Dominican residents also rotate at Mount Sinai to see how surgery is practiced in the US. Our next project in Global Surgery will focus on creating an ambulatory surgery center in rural Uganda, and training local surgeons onsite while providing them with telementoring capability.

SAGES has been influential in broadening my perspective in what is possible in the arena of global surgery. It is a premier national organization in its commitment to global surgery and reducing health disparities in developing countries. I am very thankful to be part of this organization, and I look forward to seeing the sustainable impact it has in underserved countries in the near future.

Dr. Linda P. Zhang on Her Path to Global Surgery and the Global Commitment of SAGES

Biography: Dr. Linda P. Zhang is an Assistant Professor of Surgery at Mount Sinai Hospital in New York. She is also the Director of Global Surgery for the Department of Surgery. Her scope of practice includes bariatrics, hernia, and robotics. Dr. Zhang is committed to reducing health disparities and has worked at various medical institutions abroad. She spent one year in South Sudan initiating a community health program that has now treated over 50,000 children with communicable diseases. In addition, she has been involved in surgical mission trips in the Dominican Republic, Haiti, Honduras, Ghana, and China.

Click https://www.sages.org/wp-content/uploads/2013/09/SCOPE-2017-winter.pdf to return to SCOPE Winter 2017.