Minimal invasive surgery

Minimal invasive surgery


Minimal Invasive Surgery (MIS) is a “transferable competency” which requires the acquisition of “Knowledge” in basic clinical sciences 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 non-acute 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 and medical specialties, e.g. anesthesia and intensive care, emergency surgery, gastroenterology, general surgery, internal medicine, radiology, neurology, pediatrics, oncology, obstetrics and gynecology, urology and others in the management of patients.

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

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

Eligibility for “MIS centres” is usually 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.

What is a Minimal Invasive surgeon?

The surgeon must have acquired and must maintain specialised “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
  • Alimentary tract,
  • Thoracic wall and organs,
  • Minimal invasive surgery techniques, especially laparoscopic and thoracoscopic procedures,
  • Thyroid gland, parathyroid gland, adrenal glands
  • 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
  • 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, which 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 in 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 including the principles of enhanced recovery and follow-up of patients. The specialty also includes individual and general preventive activities, rehabilitation, palliation and management of pain, especially in oncologic patients.

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.

Minimal invasive surgery Working group statutes & Board

Minimal Invasive Surgery (MIS) is a Working Group within the “Section of Surgery” which was formed in 2015 to prepare specific advice on issues relating to training, harmonisation, standardisation of training and professional practice in Minimal Invasive Surgery (MIS) within the UEMS countries for the benefit of training in MIS and patient care.

The “Working Group of MIS” is a non-profit organisation.

The European Board of Minimally invasive surgery