Europe is a diverse and dynamic continent with enormous differences among healthcare systems. There are noticeable differences between countries with regards to accessibility of resources, financial investment in the medical sector and training opportunities. There are also differences between countries and within countries with regards to the practice of neonatal and pediatric endoscopic surgery. Not to mention that there are centers that do not offer endoscopic surgery in the school-age and adolescent age groups. Endoscopic surgery in pediatric and neonatal patients has become more popular throughout Europe in the past 2 decades as the advantages have become more evident and it was essential to promote training across the continent.

Programs and courses organized by local Pediatric Surgical Societies commenced and focused on regional trainees in local languages. There were, however, wide differences in these programs with respect to the training set-up and the expertise of faculty members that contributed to them. More organized efforts were necessary to meet the demands of teaching and training in neonatal and pediatric endoscopic surgery across Europe.

The European Paediatric Surgeons’ Association (EUPSA) which is the umbrella organization for pediatric surgeons in the continent recognized these inequalities and embarked on the organization of training and education in endoscopic surgery. Initial efforts of the EUPSA in the early 2000s commenced with organization of annual pre-congress courses that included teaching as well as pelvitrainer-based hands-on training. The low cost of this courses during the Congresses along with an expert teaching faculty attracted participants from across the continent; but the limitation of the number of participants was a drawback in allowing mass attendance. Also, the courses were completed in one day and were hence limited in both teaching and training time.

Pediatric endoscopic surgery programs were established by individual organizations as well as by EUPSA to offer training throughout the region. The programs that were in English language were offered as EUPSA approved programs. In Western Europe, these programs were and are presently being conducted in London (United Kingdom), Geneva (Switzerland), Strasbourg (France), Berlin (Germany), Braga (Portugal), Caceres (Spain), Naples (Italy) and Bologna (Italy); whereas programs in Eastern Europe are being conducted in Riga (Latvia), Timisoara (Romania), Belgrade (Serbia) and Baku (Azerbaijan). These programs are announced through EUPSA social media platforms that reach out to large sections of the pediatric surgical community within Europe and beyond.

The English language courses listed above have the possibility to engage faculty from across the continent as well as international experts which has been the advantage in the success of these courses. The courses are also held over a period of 2 days which offers more hands-on training time and the longer possibility to interact with experts during theoretical teaching sessions. Often a disadvantage of these courses is the high cost for the trainees, as there is wide disparity in pay between the medical professionals throughout Europe, with the difference more affecting those in Eastern Europe. Bearing this is mind, EUPSA has offered financial support to the courses in Eastern Europe, hence reducing the fee for participants from the region and encouraging their training in pediatric endoscopic surgery.

The curriculum in these courses focuses on the main topics in approach to neonatal pathologies, laparoscopic and thoracoscopic procedures. Many courses have also integrated pediatric endoscopic urology as part of the curriculum as well as have offered hands-on training focused specifically in this area. With more application of robotics, some courses have incorporated this as part of their programs.

Unlike adults, there has been a change in pediatric surgical endoscopic surgery in the past decade mainly in terms of shifting from 5 mm instruments to 3 mm instruments training courses. This change was deemed necessary as endoscopic surgery swung towards increased management of neonatal conditions. This also offered further challenges as pediatric endoscopic surgical training required training both in 5 mm as well as 3 mm instruments.

Training in neonatal and pediatric courses, however, differs in terms of the models being offered to practice and develop skills. These range from exercises on specially designed silicone models, live tissue as well as live anesthetized models. As most courses do not have entry requirements, they are attended by novices as well as participants performing endoscopic procedures. Hence, courses have been structured in such a manner that exercises are introduced with increasing levels of difficulties through the duration of the course. Besides training courses, live operative workshops are offered as courses, or part of some courses, to observe procedures performed by expert surgeons.

Live operation workshops have advantages as they enable participants to witness complete procedures while interacting with the faculty performing the surgery. An important aspect in live workshops is that participants are able to observe operation room setups as well as team positioning; an important part of the procedure with regards to ergonomics of the operating room in index cases. Technical challenges encountered by the operating team during procedures and their resolution also offers considerably towards the training in terms of trouble shooting, avoiding pitfalls and approach to unexpected situations.

Rolling out these programs throughout Europe has been supported by the industry that has offered enormous resources and sustained assistance for training. Success in pediatric and neonatal endoscopic surgical training programs across Europe has been achieved to a large extent keeping in mind the unique challenges, aspirations and expectations of its surgeons.

Amulya K. Saxena.

Editor-in-Chief.