Training in Esophagogastric Surgery in the Era of Minimally Invasive Procedures

Abstract

Training in esophagogastric surgery is undergoing significant change driven by the widespread adoption of minimally invasive techniques - laparoscopic, thoracoscopic and robotic. The classical Halstedian model of surgical education, based on the linear progression of "see one, do one, teach one" under a single mentor, established in 1904, is no longer sufficient given reduced resident working hours, decreased direct operative exposure, and the increasing technical complexity of modern procedures. This article reviews the historical evolution of surgical education and examines the pillars of modern training in esophagogastric surgery: structured fellowship programs, stepwise technical training, simulation- based practice, and proctorship. The demanding learning curve of these procedures is discussed, together with a synthesis of international evidence on resident training in minimally invasive surgery, which shows increasing but uneven exposure, frequently nonstandardized curricula, and a persistent gap in readiness for independent practice at graduation. The growing role of robotic surgery, artificial intelligence and telemonitoring, and the importance of non- technical skills for patient safety are also addressed. The article concludes that the future of surgical training should rely on a holistic, competency- based model, integrating knowledge, technical skill and interpersonal competence, assessed through the framework of Entrustable Professional Activities, and supported by closer collaboration between hospitals, clinics and teaching institutions.