The Indian Chapter of World Association of Laparoscopic Surgeons, a standing committee of the International organization for the promotion of laparoscopic surgery among surgeons and gynaecologists, is attempting to address the needs of rural surgeons through a variety of initiatives, spearheaded by its subcommittee on rural surgery.

Large rural communities generally have at least several general surgeons, a variety of subspecialty surgeons and medical counterparts. Most of the rural setup lack state-of-the-art facilities and equipments for laparoscopic surgery. Small rural communities have also very limited human and technical resources. Surgeons are often solo practitioners with limited subspecialty  suport and trained staff. Their scope of practice is broader than that of their urban counterparts, and includes a large volume of patient who need laparoscopy. Surgeons in small rural hospitals are usually very busy practitioners. They are the main target audience fo the efforts of the World association of laparoscopic surgeons advisory council rural srugery liasion group.

The debate over case volumes presents a particular threat to surgeons in small-volume hospitals. The previous generation of surgeons was considered competent as long as  they mastered basic surgical techniques and applied them to a large volume of cases in an active practice. With the exception of a few highly specialized techniques, they are permitted, and expected, to perform a wide variety of technically demanding operations. The new paradigm appears to demand that surgeons master atleast few essential minimal access procedures and perform them to the exclusion of all others.

It should come as no surprise that recruitment of yound surgeons to rural pratice is increasingly difficult. Medical students, and reidients have little or no exposure to laparoscopy. Their perception of minimal access surgery is often distroed. What they see suggests surgeons who take lots of call and are permitted to apply relatively few of the skills acquired during a demanding residency. They are commonly encouraged to take a fellowship beyond basic general surgery training, and are overtly or subtly discouraged from considering rural practice. Rural surgeons are old that their urban counterparts, and replacements are lacking. Access to care in small communities will be an ever-increasing problem unless something is done to reverse these trends.

Fortunately, good evidence exists that those surgeons who, despite all odds, decide to forcate in a small town, can still have a rewarding and satisfying professional career. Most patients prefer to have their care locally, provided it is competent. Surgeons  keep small hospitals alive, are often leaders in their communities, have busy practices, and enjoy the respect and appreciation of theri friends and neighbors. Rural surgeons are needed. Where demand exists, so does opportunity.

Accordingly, the advisory council of WALS encourages individual surgeons in small towns to maintain high standards, including certifications, record their cases, and participate in peer review activities. As new technology is validated, they should learn it, and introduce it into their practices carefully and ethically. Organized surgery should assist rural surgeons in education, skill maintenance, and acquistion of new technology, preferably in learning centers that are attuned to the special needs of these key practitioners. Collaboration between surgical organizations such as WALS in thes matters will help assure access to high-quality surgical services by rural and other underserved populations.