Teaching Advanced Laparoscopic Skills in Surgery for Morbid Obesity

  • Alice Yi-Chien TsaiEmail author
  • Alan Osborne
  • Richard Welbourn


Obesity is a serious public health issue in the Western world and rapidly climbing in developing countries. The data overwhelmingly suggest that bariatric surgery is currently more effective than conventional medical therapy. As the volume of bariatric surgery is increasing worldwide, it is essential to safeguard the standard of bariatric training and facilities that provide bariatric services.

Bariatric operations were originally designed as a restrictive procedure, such as gastric band and sleeve gastrectomy, or mal-absorptive procedures, such as Roux-en-Y gastric bypass. Laparoscopic bariatric surgery requires mastery of a broad range of cognitive and technical skills, including the management of severely obese patients. In the UK, the bariatric training pathway cumulates in a fellowship of 6 months to 1 year. During a bariatric fellowship, trainees start by learning the skills required in laparoscopic gastric banding including access in obese patients, trocar placements, liver retraction, pars flacida approach and laparoscopic suturing. Once these competencies are achieved, trainees progress to learning more challenging procedures such as laparoscopic Roux-en-Y gastric by-pass (LRYGB).

Structured training programmes adapt the teaching methods to the learning styles of trainees and facilitate trainees to go through the learning cycle under close supervision to minimise the proficiency-gain curve effect. Video-enhanced feedback forms an integral part of continuing self-reflection and assessment. Bariatric fellowships should be based in bariatric centres that can provide sufficient exposure, adequate case volume and variety of operations, and meet the professional standards for delivering patient-centred multidisciplinary care.


Bariatric Obesity Roux-en-Y Gastric Bypass Weight Loss Proficiency-gain curve 


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Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Alice Yi-Chien Tsai
    • 1
    Email author
  • Alan Osborne
    • 2
  • Richard Welbourn
    • 3
  1. 1.Upper Gastrointestinal SurgeryMusgrove Park HospitalTaunton, SomersetUK
  2. 2.Department of Bariatric SurgeryNorth Bristol NHS Trust, Southmead HospitalBristolUK
  3. 3.Dept Upper GI and Bariatric SurgeryMusgrove Park HospitalTaunton, SomersetUK

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