General Surgery NewsSurgical Agoraphobia

🎓 Expert Commentary / Peer Perspective

Decades of laparoscopic and robotic adoption have changed how surgeons train and operate, but Frederick L. Greene, MD, argues that this success carries a potential training consequence. He describes “surgical agoraphobia” as reluctance or discomfort with traditional open surgery among clinicians trained predominantly in minimally invasive environments. The central concern is not resistance to technological progress. It is whether reduced open-procedure experience can compromise judgment about when conversion is necessary, particularly when minimally invasive approaches become difficult or unsafe.

Professional Impact

• The commentary identifies declining exposure to traditional open procedures as a potential training vulnerability as laparoscopic and robotic approaches expand.
• Its central concern is judgment, not simply technical proficiency: recognizing when circumstances warrant abandoning a minimally invasive approach.
• Greene argues that limited open operative experience could contribute to delayed conversion and potentially dangerous judgment errors.
• The author proposes preoperative discussion of conversion criteria between senior faculty and trainees before laparoscopic and robotic procedures.
• He also sees experienced senior surgeons as a potentially valuable educational resource, including clinicians no longer routinely operating.
• The article presents an expert perspective, not comparative evidence linking minimally invasive training patterns to patient outcomes or documenting the prevalence of the proposed phenomenon.

Action Items

• Review how surgical training programs maintain exposure to the principles and decision-making involved in open procedures.
• Discuss potential indications for conversion before laparoscopic and robotic cases as part of operative preparation.
• Evaluate whether simulation, operative video review, and senior-surgeon mentorship can supplement declining direct exposure to open surgery.
• Preserve conversion judgment as a training objective independent of proficiency with minimally invasive technology.