Intraluminal endoscopy in surgery. The german protocol Stampa
Venerdì 03 Settembre 2010 09:54

The German Society of Surgery has a Surgical Working Group for Endoscopy, founded in 1976 by Prof. Dr. H.W. Schreiber in Hamburg. The foundation committee concluded as their aims and goals: - The preception of real surgical regards in endoscopy and laparoscopy – diagnostic, therapeutic and in follow up - The establishment of guide-lines for diagnostic and therapeutic indications, complementary to classic operative procedures - The disease specific interdisciplinary cooperation - Standardisation of endoscopic education, equipment and evaluation - The systematic exchange of experiences by practical and theoretical training programmes

In the meantime 38 Symposia in different places in Germany and Austria were held with a participation of 80-200 persons per session. The total membership of our working group amounts up to 587: they are all surgeons in all positions: directors, chiefs, assistants. The German Surgical Working Group for Endoscopy is not an autonomous society with own budget, annual fees and own treasurer. It is a small subdivision of the greater German Society of Surgery. All members of the working group have to be a membership in the mother society. Therefore we have no special gazette or newsletter. We have to give an annular report about our activities. The journal „Surgical Endoscopy“, founded by us, has the ideal not the financial support of the German Society of Surgery. It is now the official journal of SAGES and EAES. What we have, are our meetings, 2-3 times a year, the next in Muenster, Berlin and Cottbus. Our working group offers several training courses, basic and advanced, consistent to learn endoscopic techniques, description of endoscopic findings and to endorse quality assurance. The courses close by final examinations practical and written by multiple choice. The participation will be testified by certifications, issued by the German Society of Surgery and by the surgical professional organisation. For more practical insight into indications, performances, risk managements etc. in flexible endoscopy, a list of about 32 centers of competence in surgical endoscopy is established, where trainees can stay as visitor for one or two weeks. This is the status quo of our working group. Its main objective was and furtherhin is to maintain and to justify the real surgical interests in all methods of endoscopy, diagnostic and therapeutic of the gastrointestinal tract and tracheo-bronchial tract as well, in all ages with no restriction to certain manoevers and instruments. Endoscopy is surgery. There are two new movements in german Surgical Endoscopy. First: the formation of a new special working group for minimally invasive surgery: „CAMIC“. That means, the laparoscopic surgeons separated from our group forming a new one for their own. They felt underrepresented in our symposia. This might be, or even not. Nevertheless the name of this group „Group for Minimally Invasive Surgery“ really is not well choosen. ERCP, ERCP-associated procedures, stenting, hemostatic techniques, all these are minimally surgery also. It is a serious fault to confine minimally invasive surgery to the aseptic operating theatre with sluices und sterile wearings. Minimally invasive surgery by flexible endoscopy has a much greater frequency of settings, is more ambulatory and has an open access to the intervention rooms, separated for gastroscopy, colonoscopy, therapeutic interventions, ERCP and proctology. My Department of Surgical Endoscopy now is under reconstruction in an area of more than 640 m2. The second movement in the German surgical microworld are certain unreflected agreements between representatives of the German Society for Visceral Surgery and the German Society for Gastroenterology. In this dialogue, the visceral surgeons are represented by 2 not self endoscopy-performing persons, whereas the 3 gastroenterologists are personally highly engaged in gastrointestinal endoscopy. In February of this year this unequal committee has defined what surgical endoscopy might be: - surgical endoscopy is preoperatively the endoscopic definition of resection lines - surgical endoscopy are all intraoperative endoscopic procedures. - surgical endoscopy is postoperatively the endoscopic controll of anastomoses and fundoplications, the diagnosis – but not the endoscopic therapy of postoperative complications. According to this agreement, the priviledge of gastroenterology is: - the endoscopic screening - the primary diagnosis of gastrointestinal disease - the invasive diagnostic procedures like ERCP and PTC - the whole complex of interventional endoscopy Our surgical working group for endoscopy did not accept this resolution and reclaims: All diagnostic and therapeutic flexible endoscopic techniques gastrointestinal, tracheobronchial in all ages – without restriction to methods or instruments are original surgical procedures. Looking around the world, the SAGES has defined gastrointestinal endoscopy in her bylaws: diagnostic and therapeutic flexible endoscopy is part of surgical interest as it relates to gastrointestinal or abdominal diseases. This society supports and encourages academics, clinicians and research to involve in gastrointestinal endoscopy as an integral part of gastrointestinal surgery. The training of surgical residents in the United States includes flexible endoscopy – and they perform it as surgeons in surgical endoscopic departments. In Japan gastrointestinal endsocopy is performed by both: general surgeons and gastroenterologists. There is no unproductive competition. There are two big national japanese endoscopic societies: The Japanese Society for Gastrointestinal Endoscopy with 27.000 members (70 % gastroenterologists, 30 % surgeons) and the Japanese Society for Endoscopic Surgery with 4.000 members (60 % visceral, 30 % chest surgeons). In Germany we have 3 societies: The German Society for Gastroenterology with a section for endoscopy, about 4.000 members (90 % physicians and gastroenterologists), the German Society for Endoscopy and Imaging, about 730 members (14 % Surgeons) and our Working Group for Surgical Endoscopy with 587 members, exclusively represented by surgeons. What is the future of endoscopy? Diagnostic gastrointestinal endoscopy, screening and minor therapeutic procedures will be covered by physicians and gastroenterologists and coloproctologists in their practice. But the bleeders, the big polyps, the risky situations, the obstruction of the esophagus or the bile ducts or elsewhere, the anxious or painful patients, the child – all these need a clinical setting with an experienced interventional endoscopist, an anaesthesiologist and a surgeon at the same time and at the same place. And where is his collegium? It is in the until now Virtual Institute of Clinical Endoscopy - with an endoscopic service round the clock - with a trunc of specially trained nurses - with a trunc of assistants, destinated for a whole day endoscopic service and this for a minimum of two years. This Institute for Clinical Endoscopy has its own budget, a small ward for 6-8 beds and its own chief. The chief is independent from the unit of gastroenterology, independent from the unit of surgery. This institute is more affiliated to the operative than to the conservative disciplines. One institute will be needed for a population of 1-2 million. This might be a vision for the future. You have founded today the Italian Society for Surgical Endoscopy. This is a mile stone in the reestablishment of surgical interests in endoscopy and another highlight floating from your country over Europe. Renaissance allways took its way from Italy. Bernd C. Manegold Salerno, 4 ottobre 2001 Lettura inaugurale, I Congresso Nazionale ISSE, Salerno, 4-6 ottobre 2001