metabolic bariatric procedures. Multiple combined preclinical and clinical training modules (i.e., weekend courses, mini fellowships) allowing metabolic bariatric surgeons to master the laparoscopic procedures are available.13 With most metabolic bariatric cases performed laparoscopically, residents and fellows have to learn these procedures without experience in open gastric bypass and sleeve operations. However, as these novice surgeons use laparoscopy from the start of their training, their laparoscopic learning curve may be shortened. Moreover, they can build on the pioneering work of previous surgeons, with a subsequent shorter learning curve.14,15 Although the learning curve for gastric bypass procedures has previously been suggested to lie between 50 and 150 procedures to reach a standard procedure time and complication rate, the learning curve for bariatric naïve novices such as residents and fellows has not been defined.4 Solid clinical training of residents and fellows can improve results and reduce learning curve related complications. Training may include physical model and virtual reality simulators, animal, and cadaver models, and also pre-, per- and postoperative guidance and instruction. A systematic review of Beyer-Berjot et al. on training in advanced abdominal laparoscopic surgery included 54 studies, but only 5 of those refer to bariatric surgery, of which 3 describe the laparoscopic adjustable gastric band and only 2 the LRYGB.16 Therefore, evidence on the training of the gastric bypass and sleeve gastrectomy is still lacking. This systematic review provides an overview of current teaching methods of the most common bariatric procedures, the laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG), to residents and fellows. METHODS A systematic review was performed using medical databases PubMed-Medline, Embase, and the Education Resources Information Center (ERIC). Searches were dated November 1, 2015. A broad search was performed in PubMed and Embase using the Mesh terms Bariatric Surgery, Medical Education and Learning, and related text words. For ERIC, the keywords “bariatric surgery,” “gastric bypass,” and “gastric sleeve” were used. Duplicates were removed by matching titles and authors. 26 2
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