Exclusion Criteria By means of a predefined list titles referring to robotic surgery, laparo-endoscopic single-site surgery (LESS) or single incision laparoscopic surgery (SILS), biliopancreatic diversion and laparoscopic adjustable gastric banding were excluded. Studies focusing on obesity-related comorbidity such as obstructive sleep apnea, hernia, and pancreatitis, and other subjects not related to primary metabolic bariatric surgery such as dermatology and cosmetic and plastic surgery were also eliminated. As the search criteria included “training” and “exercise,” studies focusing on patient training and patient exercise, diet and nutrition were removed. Inclusion Criteria Two independent reviewers (M.A.K. and G.H.v.R.) independently selected titles. Only abstracts describing resident or fellow learning were selected, excluding studies solely describing learning curves or education of fully trained surgeons. Next, full-text peer-reviewed articles were included if selected by one or both reviewers. Both reviewers fully and independently assessed the selected full texts. In case of disagreement, articles were discussed until consensus was reached. Data Extraction The final selection was analysed for type of procedure, laparoscopic experience, education level, and types of tests. Outcomes included operation times and complications. Study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.17 RESULTS Article Selection In total, 2442 titles were identified in the search; 388 duplicates were removed. Based on previously described exclusion criteria, 486 titles were excluded, and another 1292 were considered irrelevant. Sixty-two of 276 remaining titles were selected based on abstract. Eighteen of those were not published as a full-text peer-reviewed article. Fourteen out of these 44 articles were included in this systematic review after full text assessment. The selection process is displayed in Figure 1. 2 27 Current techniques of teaching and learning in bariatric surgical procedures
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