Outreach training model for accredited colorectal specialists in laparoscopic colorectal surgery: feasibility and evaluation of challenges

Surgical skills training for practicing surgeons founded on established educational theories and frameworks

Following completion of structured training in residency or fellowship programs, surgeons need to acquire new skills throughout their careers to address changes in their surgical practices, and to perform new procedures and use new technologies as these are developed. The opportunities available to surgeons to acquire the new skills, safely introduce these skills into surgical practice, and then maintain the skills, vary greatly and may not fully support a surgeon's needs. The article shares background information relating to the vexing problems, and describes established educational theories and frameworks as well as specific frameworks relating to surgical skills training and verification that may be used in designing and implementing comprehensive and impactful surgical skills training programs aimed at practicing surgeons. A number of practical strategies based on these theories and frameworks are highlighted. National professional organizations and academic medical centers need to play a critical role in pursuing such efforts, which will remain pivotal in supporting the professional work of surgeons and in providing optimal surgical care well into the future.

Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN)

BACKGROUND

Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes.

METHODS

This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate.

RESULTS

A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞).

CONCLUSIONS

Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.

Comparison of textbook versus three-dimensional animation versus cadaveric training videos in teaching laparoscopic rectal surgery: a prospective randomized trial

AIM

The aim of this prospective randomized study was to compare the effectiveness of various educational tools in laparoscopic rectal surgery, including surgical textbooks, animation and cadaveric videos.

METHOD

Initially, an electronic assessment test assessing knowledge of laparoscopic rectal surgery was created and validated. The test was sent to graduates completing a general surgery residency programme in Turkey, who were then randomized into four groups based on the type of study material. After a 4 week study period, the volunteers were asked to answer the same electronic assessment test imported into an edited live laparoscopic rectal surgery video. Pre- and posteducation assessment tests among the groups were compared.

RESULTS

A total of 168 volunteers completed the pre-education assessment test and were randomized into four groups. Pre-education assessment test scores were similar among the groups (p > 0.05). Of 168 volunteers, 130 (77.3%) completed the posteducation assessment test. Posteducation assessment test scores were significantly higher in the three-dimensional (3D) animation + cadaveric video group (p < 0.01), the 3D animation group (p < 0.01) and the cadaveric group (p < 0.01) compared with the textbook group. Moreover, posteducation assessment test scores were significantly higher in the 3D animation + cadaveric video group than the 3D animation group (p < 0.01). Each group's posteducation assessment test scores were significantly higher than the pre-education assessment test scores, with the exception of the textbook group.

CONCLUSION

Our study demonstrates that 3D animation + cadaveric videos, 3D animation alone and cadaveric videos are all superior to a surgical textbook when teaching laparoscopic rectal cancer surgery. Finally, our results show that 3D animation and cadaveric videos are also superior to textbooks in enabling an understanding of rectal surgery.

Acquiring Advanced Laparoscopic Colectomy Skills - The Issues

Colorectal surgery has been revolutionised towards minimally invasive surgery with the emergence of enhanced recovery protocol after surgery initiatives. However, laparoscopic colectomy has yet to be widely adopted, due mainly to the steep learning curve. We aim to review and discuss the methods of overcoming these learning curves by accelerating the competency level of the trainees without compromising patient safety. To provide this mini review, we assessed 70 articles in PubMed that were found through a search comprised the keywords laparoscopic colectomy, minimal invasive colectomy, learning curve and surgical education. We found England's Laparoscopic Colorectal National Training Programme (LAPCO-NTP) England to be by far the most structured programme established for colorectal surgeons, which involves pre-clinical and clinical phases that end with an assessment. For budding colorectal trainees, learning may be accelerated by simulator-based training to achieve laparoscopic dexterity coupled with an in-theatre proctorship by field experts. Task-specific checklists and video recordings are essential adjuncts to gauge progress and performance. As competency is established, careful case selections with the proctor are essential to maintain motivation and ensure safe performances. A structured programme to establish competency is vital to help both the proctor and trainee gauge real-time progress and performance. However, training systems both inside and outside the operating theatre (OT) are equally useful to achieve the desired performance.