Background

The Norwegian National Advisory Unit on Advanced Laparoscopic Surgery (Norwegian abbreviation NSALK) was established at the Regional Hospital of Trondheim in 1995 (now St. Olavs) and was officially opened the following year.

Laparoscopic surgery (MIS or keyhole surgery), which has undergone rapid development in Norway after it was introduced in the early 1990s, has a number of advantages: less pain for the patient, reduced hospitalization time and faster recovery. Compared to traditional surgery, laparoscopic surgery gives socio-economic savings.

The transition from open to laparoscopic surgery is a major challenge. When new techniques are to be implemented, medical personnel have to be trained. NSALK's mission is to offer that training and raise competence in the field, and ensure that all Norwegian hospitals can share in this expertise.

Why establish a National Advisory Unit for laparoscopic surgery?

Even though laparoscopic surgery has proven to reduce socio-economic costs and to reduce patient trauma, open surgery still appears to be the preference in a number of procedures where laparoscopic alternatives exist. It is therefore important to provide the foundation from which the advantages of minimal invasive surgery can be utilized to the benefit of the highest possible number of patients. This can be achieved by providing regular and systematic training of surgeons, combined with clinical and technological research and development. And this is where NSALK plays a key role.

Compared to open surgery, laparoscopic surgery gives less unimpeded sight, minimal tactile feedback and requires a high level of motor skills on the part of the operating surgeon. Good training is thus vital for those who are to perform laparoscopic procedures. Virtual Reality simulators and pelvic trainers are important tools used in the training of surgeons (Satava, 2001; Schout, 2010; Seymour, 2008). To this end NSALK aims to lead the way by providing courses with a high degree of practical exercises, by undertaking research and development in the field and by quality assuring surgical skills through certification programs (Vapenstad, 2011).

Minimal invasive surgery is constantly developing. The latest trends include endoluminal surgery (surgery on the surface of the digestive tract), NOTES (Natural Orifice Transluminal Endoscopic Surgery), LaparoEndoscopic Single Site Surgery (LESS) and robotic surgery. Bearing this in mind, NSALK, in cooperation with the Norwegian National Advisory Unit on Ultrasound and Image Guided Therapy, intends to research and develop new clinical and technological techniques using navigation (Lango, 2008) and ultrasound-guided treatment (Solberg, 2009; Våpenstad, 2010), and position sensors on surgical instruments.

Other challenges in laparoscopic surgery which NSALK is addressing through its research and development, are ergonomic designing of laparoscopic instruments, creating instruments that provide tactile feedback and training operation teams.

Tasks

NSALK is responsible for training surgeons, carrying out research and providing quality assurance of procedures in advanced laparoscopic, endoscopic and minimal invasive surgery. NSALK aims to be a leading advisory unit of expertise promoting the implementation of minimal invasive surgery in Norwegian hospitals.

The task of the Norwegian National Advisory Unit on Advanced Laparoscopic  Surgery is to monitor, develop and present competence on the national level. The unit will increase the use and quality of laparoscopic/endoscopic/minimal invasive surgery.

Bearing these aims in mind, NSALK has prepared a national competence-raising plan to improve the level of knowledge in the field of laparoscopic surgery.

The plan has the following performance targets:

1. Strengthen and raise competence and skills relating to laparoscopic/endo-scopic/minimal invasive surgery, and ensure that it will be represented in all Norwegian hospitals.
2. Develop new surgical procedures and medical technology according to clinical needs
3. Improve existing and new methods of minimal invasive surgery through testing, quality assurance, training and guidance.

The unit aims to raise the skills in laparoscopic surgery of surgeons across Norway and to focus on minimizing the incidence of complications during this type of operation.

As a national advisory unit, under the direction of the Clinic of Surgery at St. Olavs Hospital, NSALK receives grants from the Ministry of Health and Care Services.