Why Flexible Endoscopy is Important to General and Digestive Surgeons and how are we going to Teach it to Surgeons?

Introduction. Interventional flexible endoscopy is progressively supplanting many surgical procedures. This leads to a decrease in the number and types of operations performed by surgeons. While only a handful of NOTES procedures have become common practice, it has stimulated interest in endoscopic interventions like ESD, endoluminal bariatric procedures, hybrid polypectomy, fistula and perforation repair, etc. Training in and access to, flexible endoscopy for surgeons are highly variable from country to country. In countries where surgeons are trained in endoscopy, training criteria are being strengthened and specialty societies are sponsoring "flexible endoscopy for surgeons" courses. In France, where surgeons are not traditionally trained in endoscopy, the situation is more difficult. There are few training opportunities for surgeons and no procedure to train surgery residents or fellows and almost no pathway for privileging surgeons in endoscopy in most hospitals. Conclusion. Surgeons will either learn flexible endoscopy or increasingly operations and surgical disease treatments will be relegated to our medical endoscopy colleagues. With surgeons relegated to a few basic procedures and incapable of managing complex disease states, the interest in a surgical career will continue to decline and projected deficits in surgeons to care for our aging population will accelerate alarmly. France must introduce flexible endoscopy into the basic curriculum of surgery residency training, perhaps using the model of the US flexible endoscopy curriculum, and "FES" validated certifying exam. Post-graduate courses in applications of flexible endoscopy to surgical practice should be supported and surgeons encouraged to participate. Finally, the Académie National de Chirurgie must work with the endoscopy societies to secure the rights of surgeons to become credentialed in flexible endoscopy and to access endoscopy equipment and suites in French hospitals.