key: cord-0982544-g9u8nf3t authors: Wong, W. S. Felix; Wong, Peng Hao; Lee, Man Hin; Li, Thomas; Zhang, Lian; Lee, Chyi-Long title: A Proposed High-intensity Focused Ultrasound Training Program in Hong Kong date: 2022-02-14 journal: Gynecol Minim Invasive Ther DOI: 10.4103/gmit.gmit_40_21 sha: b74a23f75445bdc9aba141fcc38eac7be1d0be65 doc_id: 982544 cord_uid: g9u8nf3t High-intensity focused ultrasound (HIFU) surgery is a noninvasive thermal ablation treatment modality, and its clinical application is increasingly introduced into gynecological practices in China and Asia. To further strengthen the technology's standardized management, the Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy (APAGE) collected the consensus of well-known experts in the field. They shared opinions on the management standards of the basic requirements for developing this HIFU technology in medical institutions, operators’ training requirements, technical management, HIFU training program, etc., Based on the recommendations from APAGE, Hong Kong Focused Ultrasound Surgery Association developed its proposed HIFU training program for gynecologists in Hong Kong. This paper will present the training requirements and hopefully share its training and credentialing rationales with other HIFU medical institutes. the consensus of well-known experts in China and Asia Pacific countries. They have multiple discussion meetings on the requirements of HIFU medical institutions, operators, technical management, etc., As the HIFU ablation services in gynecology began in the private sector in Hong Kong, its requirements for training and credentialing might be, at its early stage, under the Focused Ultrasound Surgery Association co. Ltd (FUSA) was formed by a group of registered medical specialists in Hong Kong. They have recommended the following requirements for HIFU services and proposed a training program for credentialing the practice. This paper suggests a proposed training program in Hong Kong; hopefully, it may form a framework to develop a common training program that can be accredited throughout Asia-Pacific. 1. Basic requirements of HIFU medical institutions or centers i. Medical institutions or centers should have the approval and be registered by the Hong Kong Government health authority for focused ultrasound ablation services ii. Equipment: (a) A focused ultrasound ablation treatment system for clinical use, with complete government approval documents. (b) A multifunctional medical monitor which can monitor ECG, respiration, blood pressure, pulse, and oxygen saturation during the ablation treatment; (c) Facilities for cardio-pulmonary resuscitation include oxygen channels, manual pump, air masks, sputum aspirators, plus other first-aid equipment and medicines. (d) at least 4-5 G telecommunication systems connected to accreditated HIFU centers in Hong Kong or China where online training can be provided via remote video supervision. This HIFU technology can be operated via today's telemedicine, as reported in the literature [5] iii. Staff-All medical doctors performing HIFU must be adequately trained in all technical aspects. The medical director ensures that the practicing doctors, nursing staff, and anesthetists are fully registered and qualified iv. In a hospital or a medical center, the HIFU treatment theater should be designed and able to conduct the focused ultrasound ablation surgery. It has to meet a traditional hospital's operating theater requirements or newly designed HIFU theater in a clinic. [ These cases [ Figure 1 ] include skill training by: a. Level-1-observation + hands-on training in China or Hong Kong (at least study ten patients) b. Level-1-independently operating HIFU ablation for level-1 cases by either online telemedicine or on-site preceptor's supervision (at least study ten patients). After completing a minimum of 20 cases, level-1 training is completed after a clinical assessment by an independent supervisor. These cases include skill training by: • Level-2 cases [ Figure 2 ] observation + on-site preceptor's training (at least study ten patients) • Level-2a includes: Independently operating HIFU ablation for level 2a cases by on-site supervision in Hong Kong (at least study ten patients) • Level-2b includes: Independently operating HIFU ablation for level 2b cases by on-site supervision in Hong Kong (10 study patients). After completing a minimum of 30 cases, level-2 training is considered completed. Final Assessment x 1-2 cases by HIFU preceptor before a certificate of completed training is issued. Then, the trainee can operate on his patients independently. However, ongoing support for online supervision or on-site preceptor supervision can be arranged. The requirements of a training center are listed in Table 3 . Before the widespread acceptance of the HIFU technology, the community must recognize its safety, effectiveness, and training accreditation. Ultrasound-guided HIFU ablation is an effective and noninvasive treatment for fibroids and adenomyosis, which was developed and endorsed in China. However, there has not been any training program overseas because it was not introduced widely outside China. This paper aims to present the training program in Hong Kong for this new procedural technology. It focuses on teaching technical knowledge, hands-on training, and supervised training at different skill level procedures. China also sets up a well-established. Expert consensus group to regulate the HIFU training and applications. [7] Then, who should be responsible for the safe introduction of new surgical technology in Hong Kong? Unlike minimally invasive surgery, this HIFU technology does not have training platforms similar to MIS, such as virtual reality (VR) training, bench model simulations, cadaver, and live animal model surgery. Besides, MIS training is readily available in many medical institutes or private hospitals. Like the da Vinci robotic surgery, HIFU ablation is heavily involved in the smooth operation and application of a machine. There is a consensus that we should be wary of training standards promoted by machine manufacturing companies. In 2017, the Washington State Supreme Court ruling in a case of medical litigation implied that surgeons learning a new surgical technology promoted by companies was clearly insufficient. [8] Training requirements might be better designated by doctors with related surgical experience in practice. In Hong Kong, it is almost by default that the teaching, inspiring, and training of other doctors in this new technology lie flatly in the hands of the few gynecologists who had set up the first specialized HIFU surgical center 1½ years ago. [4] They also set up the FUSA, which developed this training program based on their HIFU learning experience, guided and supported by some HIFU groups and centers from China and Asia Pacific countries. Hopefully, it can provide a training program to ensure structured teaching of this new technology in Hong Kong. Based on our understanding, for our training program to be successful, several training components are important, [9] including (1) a knowledge component, Our training program is primarily for HIFU ablation of fibroids and adenomyosis in gynecology. Our pilot training program stresses the importance of acquiring the right skills for HIFU procedures of various difficulties and complexities Table 3 : Requirements for a training center 1) A medical unit that meets the technical management requirements of focused ultrasound ablation treatment 2) Relevant training center needs to carry out the HIFU ablation services for more than three years, no less than 300 cases within three years before applying to be a training center. One of the criteria for a successful application is a low incidence of <1% severe complications 3) The training center director should be a registered medical practitioner and a HIFU specialist of good character and vast experience. The center should also have at least 3 HIFU specialists as trainers and supervisors HIFU: High-intensity focused ultrasound and teaches them to gynecologists. A group decision based on surgical difficulties and safety represents the "expert consensus" on this new HIFU technology. Leading communities worldwide would benefit from standardizing and validating our training program for its effectiveness in teaching surgical competence, minimizing wasted time in learning, and focusing on the breadth of skills needed for a new HIFU surgery. Nil. Prof. Wu Shun Felix Wong and Prof. Chyi-Long Lee, editorial board members at Gynecology and Minimally Invasive Therapy, had no roles in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper. Magnetic resonance-guided focused ultrasound surgery for leiomyoma and adenomyosis: An alternative nonvascular approach Magnetic resonance imaging-guided volumetric high-intensity focused ultrasound surgery for pedunculated subserosal uterine leiomyoma Adenomyosis-Is a new treatment solution available? A journey from learning a noninvasive high-intensity focused ultrasound surgical treatment for gynecological diseases to providing high-intensity focused ultrasound services in Hong Kong The potential role in HIFU telehealth in the management of fibroid and adenomyosis after COVID-19 pandemic A high-intensity focused ultrasound surgery theater design in a private clinic Expert consensus on technical specification to clinical application of focused ultrasound ablation surgery Who is responsible for the safe introduction of new surgical technology? An important legal precedent from the da vinci surgical system trials Teaching procedural skills Non-invasive magnetic resonance-guided focused ultrasound treatment of uterine fibroids in a large Japanese population: Impact of the learning curve on patient outcome