Skip to main content

Laparoscopic Colon Surgery: Education and Best Practices

  • Chapter
  • First Online:
Laparoscopic Colon Surgery

Abstract

The advent of laparoscopic surgery has radically changed surgical management of many diseases. Soon after the first laparoscopic procedures, the development of more complex laparoscopic operations began, including laparoscopic colon surgery. However, the adoption of laparoscopic colon surgery created new educational challenges. Add to this the medical demands for increased patient safety, fewer complications from surgery, and less time in the hospital. These are strong forces towards the development of training tools and modalities that teach the types of skills needed in laparoscopic surgery. New and older educational modalities such as box and video trainers, high-fidelity laparoscopic simulators, and cadaveric and animal models are useful because they shorten the training period and minimize costs. Their appropriate use allows acquisition of basic and advanced laparoscopic surgical skills outside the operating theatre. Training time within the operating theater can be reserved for training integration and practicing on real tissue. Increasing knowledge of the advantages and limitations of different educational and training modalities is necessary so best practices can be implemented. As laparoscopic colon surgery is relatively new, it is also important to acknowledge the population of trainees is not homogenous, ranging from novice to experienced surgeons. The diverse group that comprise the surgical community, plus limitation in financial resources, make flexible and economical educational programs a necessity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1(3):144–50.

    CAS  PubMed  Google Scholar 

  2. Bardakcioglu O, Khan A, Aldridge C, Chen J. Growth of laparoscopic colectomy in the United States: analysis of regional and socioeconomic factors over time. Ann Surg. 2013;258(2):270–4.

    Article  PubMed  Google Scholar 

  3. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum. 2001;44(2):217–22.

    Article  CAS  PubMed  Google Scholar 

  4. Celentano V. Need for simulation in laparoscopic colorectal surgery training. World J Gastrointest Surg. 2015;7(9):185–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Heemskerk J, Zandbergen R, Maessen JG, Greve JWM, Bouvy ND. Advantages of advanced laparoscopic systems. Surg Endosc. 2006;20(5):730–3.

    Article  CAS  PubMed  Google Scholar 

  6. Charron P, Campbell R, Dejesus S, Gallagher J, Williamson P, Ferrara A. The gap in laparoscopic colorectal experience between colon and rectal and general surgery residency training programs. Dis Colon Rectum. 2007;50(12):2023–31. discussion 2031

    Article  PubMed  Google Scholar 

  7. Gardner AK, Willis RE, Dunkin BJ, Van Sickle K, Brown K, Truitt M, Uecker J, Gentry L, Scott D. What do residents need to be competent laparoscopic and endoscopic surgeons? Surg Endosc. 2015;30(7):3050–9.

    Article  PubMed  Google Scholar 

  8. Williams GL, Sagar PM, McAllister I, Gonsalves S. The laparoscopic colorectal fellowships are popular, educational and produce competent laparoscopic surgeons. Color Dis. 2009;11(5):519–21.

    Article  CAS  Google Scholar 

  9. Stein S, Stulberg J, Champagne B. Learning laparoscopic colectomy during colorectal residency: what does it take and how are we doing? Surg Endosc. 2012;26(2):488–92.

    Article  PubMed  Google Scholar 

  10. Luglio G, De Palma GD, Tarquini R, Giglio M, Sollazo V, Esposito E, Spadarella E, Peltrini R, Liccardo F, Bucci L. Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study. Ann Med Surg (Lond). 2015;4(2):89–94.

    Article  Google Scholar 

  11. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left- sided resections. Ann Surg. 2005;242(1):83–91.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Barrie J, Jayne DG, Wright J, Murray CJC, Collinson FJ, Pavitt SH. Attaining surgical competency and its implications in surgical clinical trial design: a systematic review of the learning curve in laparoscopic and robot-assisted laparoscopic colorectal cancer surgery. Ann Surg Oncol. 2014;21(3):829–40.

    Article  PubMed  Google Scholar 

  13. Fitts P, Posner M. Human performance. Brooks/Cole: Belmont; 1967.

    Google Scholar 

  14. Reznick RK, MacRae H. Teaching surgical skills--changes in the wind. N Engl J Med. 2006;355(25):2664–9.

    Article  CAS  PubMed  Google Scholar 

  15. Gade M, Druey MD, Souze AS, Oberauer K. Interference within the between declarative and procedural representations in working memory. J Mem Lang. 2014;76(October):174–94.

    Article  Google Scholar 

  16. Masters RSW, Poolton JM, Abernethy B, Patil NG. Implicit learning of movement skills for surgery. ANZ J Surg. 2008;78(12):1062–4.

    Article  PubMed  Google Scholar 

  17. Oostema JA, Abdel MP, Gould JC. Time-efficient laparoscopic skills assessment using an augmented- reality simulator. Surg Endosc. 2008;22(12):2621–4.

    Article  PubMed  Google Scholar 

  18. Dinscore A, Andres A. Surgical videos online: a survey of prominent sources and future trends. Med Ref Serv Q. 2010;29(1):10–27.

    Article  PubMed  Google Scholar 

  19. Sugamoto Y, Hamamoto Y, Kimura M, Fukunga T, Tasaki K, Asai Y, Takeshita N, Maruyama T, Hosokawa T, Tamachi T, Aouyama H, Matsubara H. A novel method for real-time audio recording with intraoperative video. J Surg Educ. 2015;72(5):795–802.

    Article  PubMed  Google Scholar 

  20. Naumann DN, Bowley DM, McArthur DR. The director’s cut - video editing as a training modality for minimally invasive surgery. Minim Invasive Ther Allied Technol. 2014;23(3):188–9.

    Article  PubMed  Google Scholar 

  21. Way LW, Stewart L, Gantert W, Liu K, Lee C, Whang K, Hunter J. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237(4):460–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tolerton SK, Hugh TJ, Cosman PH. The production of audiovisual teaching tools in minimally invasive surgery. J Surg Educ. 2012;69(3):404–6.

    Article  PubMed  Google Scholar 

  23. Fleshman J, Marcello P, Stamos MJ, Wexner SD. American Society of Colon and Rectal Surgeons (ASCRS), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Focus group on laparoscopic colectomy education as endorsed by the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Dis Colon Rectum. 2006;49(7):945–9.

    Article  PubMed  Google Scholar 

  24. Abdelsattar JM, Pandian TK, Finnesgard EJ, El Khatib M, Rowse P, Buckarama E, Gas B, Heller S, Farley D. Do you see what I see? How we use video as an adjunct to general surgery resident education. J Surg Educ. 2015;72(6):e145–50.

    Article  PubMed  Google Scholar 

  25. Nagendran M, Gurusamy KS, Aggarwal R, Loizidou M, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2013;8:CD006575.

    Google Scholar 

  26. Ahlberg G, Heikkinen T, Iselius L, Leijonmarck C-E, Rutqvist J, Arvidsson D. Does training in a virtual reality simulator improve surgical performance? Surg Endosc. 2002;16(1):126–9.

    Article  CAS  PubMed  Google Scholar 

  27. Bashankaev B, Baido S, Wexner SD. Review of available methods of simulation training to facilitate surgical education. Surg Endosc. 2011;25(1):28–35.

    Article  PubMed  Google Scholar 

  28. Seymour NE, Gallagher AG, Roman SA, O'Brien M, Bansal P, Andersen D, Satava R. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458. -463-464

    Article  PubMed  PubMed Central  Google Scholar 

  29. Neary PC, Boyle E, Delaney CP, Senagore AJ, Keane FBV, Gallagher AG. Construct validation of a novel hybrid virtual-reality simulator for training and assessing laparoscopic colectomy; results from the first course for experienced senior laparoscopic surgeons. Surg Endosc. 2008;22(10):2301–9.

    Article  PubMed  Google Scholar 

  30. Essani R, Scriven RJ, McLarty AJ, Merriam LT, Ahn H, Bergamaschi R. Simulated laparoscopic sigmoidectomy training: responsiveness of surgery residents. Dis Colon Rectum. 2009;52(12):1956–61.

    Article  PubMed  Google Scholar 

  31. Stelzer MK, Abdel MP, Sloan MP, Gould JC. Dry lab practice leads to improved laparoscopic performance in the operating room. J Surg Res. 2009;154(1):163–6.

    Article  PubMed  Google Scholar 

  32. Zendejas B, Brydges R, Hamstra SJ, Cook DA. State of the evidence on simulation-based training for laparoscopic surgery: a systematic review. Ann Surg. 2013;257(4):586–93.

    Article  PubMed  Google Scholar 

  33. Salkini MW, Hamilton AJ. The effect of age on acquiring laparoscopic skills. J Endourol. 2010;24(3):377–9.

    Article  PubMed  Google Scholar 

  34. LeBlanc F, Champagne BJ, Augestad KM, Neary P, Senagore A, Ellis C, Delaney C. A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg. 2010;211(2):250–5.

    Article  PubMed  Google Scholar 

  35. Lee M, Savage J, Dias M, Berggren P, Winter M. Box, cable and smartphone: a simple laparoscopic trainer. Clin Teach. 2015;12(6):384–8.

    Article  PubMed  Google Scholar 

  36. Matsiota E. Laparoscopic colectomy training: a quasi experimental comparison of simulators to traditional training. 2015. http://media.proquest.com/media/pq/classic/doc/3787326151/fmt/ai/rep/NPDF?_s=jP0cUUpvVOKeJT1MmA QFuqQQRww%3D.

  37. Levine RL, Kives S, Cathey G, Blinchevsky A, Acland R, Thomson R, Pasic R. The use of lightly embalmed (fresh tissue) cadavers for resident laparoscopic training. J Minim Invasive Gynecol. 2006;13(5):451–6.

    Article  PubMed  Google Scholar 

  38. Khine M, Leung E, Morran C, Muthukumarasamy G. Homemade laparoscopic simulators for surgical trainees. Clin Teach. 2011;8(2):118–21.

    Article  PubMed  Google Scholar 

  39. Gilbody J, Prasthofer AW, Ho K, Costa ML. The use and effectiveness of cadaveric workshops in higher surgical training: a systematic review. Ann R Coll Surg Engl. 2011;93(5):347–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Zendejas B, Wang AT, Brydges R, Hamstra SJ, Cook DA. Costs: the missing outcome in simulation-based medical education research: a systematic review. Surgery. 2013;153(2):160–76.

    Article  PubMed  Google Scholar 

  41. Aslam A, Nason GJ, Giri SK. Homemade laparoscopic surgical simulator: a cost-effective solution to the challenge of acquiring laparoscopic skills? Ir J Med Sci. 2016;185(4):791–6.

    Article  CAS  PubMed  Google Scholar 

  42. Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard R, Schouenborg L, Ottosen C, Schroeder B, Ottosen B. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ. 2009;338:b1802.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Van Bruwaene S, Schijven MP, Napolitano D, De Win G, Miserez M. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial. J Surg Educ. 2015;72(3):483–90.

    Article  PubMed  Google Scholar 

  44. Hayashi S, Naito M, Kawata S, Qu N, Hatayama N, Hirai S, Itho M. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method. Anat Sci Int. 2015;91(1):1–7.

    Article  PubMed  CAS  Google Scholar 

  45. Udomsawaengsup S, Pattana-arun J, Tansatit T, Pungapong S, Navicharern P, Sirichindakul B, Nonthassot B, Park-art R, Sriassadeporn S, Kyttayakerrana K, Wongsaisuwan M, Rojanaskul A. Minimally invasive surgery training in soft cadaver (MIST-SC). J Med Assoc Thai. 2005;88(Suppl 4):S189–94.

    PubMed  Google Scholar 

  46. Giger U, Frésard I, Häfliger A, Bergmann M, Krähenbühl L. Laparoscopic training on Thiel human cadavers: a model to teach advanced laparoscopic procedures. Surg Endosc. 2008;22(4):901–6.

    Article  PubMed  Google Scholar 

  47. Leblanc F, Senagore AJ, Ellis CN, Champagne B, Augestad K, Neary P, Delaney C. Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models. J Surg Educ. 2010;67(4):200–4.

    Article  PubMed  Google Scholar 

  48. Wyles SM, Miskovic D, Ni Z, Acheson A, Maxwell C, Longman R, Cecil T, Coleman M, Horgan A, Hanna G. Analysis of laboratory-based laparoscopic colorectal surgery workshops within the English National Training Programme. Surg Endosc. 2011;25(5):1559–66.

    Article  PubMed  Google Scholar 

  49. Stefanidis D, Yonce TC, Green JM, Coker AP. Cadavers versus pigs: which are better for procedural training of surgery residents outside the OR? Surgery. 2013;154(1):34–7.

    Article  PubMed  Google Scholar 

  50. Böhm B, Milsom JW, Kitago K, Brand M, Fazio VW. Laparoscopic oncologic total abdominal colectomy with intraperitoneal stapled anastomosis in a canine model. J Laparoendosc Surg. 1994;4(1):23–30.

    Article  PubMed  Google Scholar 

  51. Böhm B, Milsom JW. Animal models as educational tools in laparoscopic colorectal surgery. Surg Endosc. 1994;8(6):707–13.

    Article  PubMed  Google Scholar 

  52. Byrne P. Teaching laparoscopic surgery. Practice on live animals is illegal. BMJ. 1994;308(6941):1435.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Rollin BE. The regulation of animal research and the emergence of animal ethics: a conceptual history. Theor Med Bioeth. 2006;27(4):285–304.

    Article  PubMed  Google Scholar 

  54. Russel W, Buch R. The principle of humane experimental technique. London: Methuen; 1959.

    Google Scholar 

  55. Dawkins M. Animal suffering: the science of animal welfare. Springer Science & Business Media; 2012.

    Google Scholar 

  56. Bishop LJ, Nolen AL. Animals in research and education: ethical issues. Kennedy Inst Ethics J. 2001;11(1):91–112.

    Article  CAS  PubMed  Google Scholar 

  57. Waseda M, Inaki N, Mailaender L, Buess GF. An innovative trainer for surgical procedures using animal organs. Minim Invasive Ther Allied Technol. 2005;14(4):262–6.

    Article  CAS  PubMed  Google Scholar 

  58. Sharma M, Macafee D, Horgan AF. Basic laparoscopic skills training using fresh frozen cadaver: a randomized controlled trial. Am J Surg. 2013;206(1):23–31.

    Article  PubMed  Google Scholar 

  59. Milsom JW, Böhm B, Decanini C, Fazio VW. Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model. Surg Endosc. 1994;8(9):1117–23.

    Article  CAS  PubMed  Google Scholar 

  60. Ross HM, Simmang CL, Fleshman JW, Marcello PW. Adoption of laparoscopic colectomy: results and implications of ASCRS hands-on course participation. Surg Innov. 2008;15(3):179–83.

    Article  PubMed  Google Scholar 

  61. Sharma M, Horgan A. Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg. 2012;36(8):1732–7.

    Article  PubMed  Google Scholar 

  62. Shanmugan S, Leblanc F, Senagore AJ, Ellis CN, Stein SL, Khan S, et al. Virtual reality simulator training for laparoscopic colectomy: what metrics have construct validity? Dis Colon Rectum. 2014;57(2):210–2144.

    Article  PubMed  Google Scholar 

  63. Samia H, Khan S, Lawrence J, Delaney CP. Simulation and its role in training. Clin Colon Rectal Surg. 2013;26(1):47–55.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Rattner DW, Apelgren KN, Eubanks WS. The need for training opportunities in advanced laparoscopic surgery. Surg Endosc. 2001;15(10):1066–70.

    Article  CAS  PubMed  Google Scholar 

  65. Reynolds FD, Goudas L, Zuckerman RS, Gold MS, Heneghan S. A rural, community-based program can train surgical residents in advanced laparoscopy. J Am Coll Surg. 2003;197(4):620–3.

    Article  PubMed  Google Scholar 

  66. Coleman MG, Hanna GB, Kennedy R, National Training Programme Lapco. The National Training Programme for laparoscopic colorectal surgery in England: a new training paradigm. Color Dis. 2011;13(6):614–6.

    Article  CAS  Google Scholar 

  67. Schlachta CM, Sorsdahl AK, Kent SA, Lefebvre KL, McCune ML, Jayaraman S. A model for longitudinal mentoring and telementoring of laparoscopic colon surgery. Surg Endosc. 2009;23(7):1634–8.

    Article  PubMed  Google Scholar 

  68. Dominguez EP, Barrat C, Shaffer L, Gruner R, Whisler D, Taylor P. Minimally invasive surgery adoption into an established surgical practice: impact of a fellowship- trained colleague. Surg Endosc. 2013;27(4):1267–72.

    Article  PubMed  Google Scholar 

  69. Daetwiler S, Guller U, Schob O, Adamina M. Early introduction of laparoscopic sigmoid colectomy during residency. Br J Surg. 2007;94(5):634–41.

    Article  CAS  PubMed  Google Scholar 

  70. Miller S, Causey MW, Damle A, Maykel J, Steele S. Single-incision laparoscopic colectomy: training the next generation. Surg Endosc. 2013;27(5):1784–90.

    Article  PubMed  Google Scholar 

  71. Champagne BJ, Lee EC, Valerian B, Armstrong D, Ambroze W, Orangio G. A novel end point to assess a resident’s ability to perform hand-assisted versus straight laparoscopy for left colectomy: is there really a difference? J Am Coll Surg. 2008;207(4):554–9.

    Article  PubMed  Google Scholar 

  72. Leblanc F, Delaney CP, Ellis CN, Neary PC, Champagne BJ, Senagore AJ. Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator. World J Surg. 2010;34(12):2909–14.

    Article  PubMed  Google Scholar 

  73. Zimmerman H, Latifi R, Dehdashti B, Ong E, Jie T, Galvani C, Waer A, Wynne J, Biffar D, Gruessner R. Intensive laparoscopic training course for surgical residents: program description, initial results, and requirements. Surg Endosc. 2011;25(11):3636–41.

    Article  PubMed  Google Scholar 

  74. Stefanidis D, Heniford BT. The formula for a successful laparoscopic skills curriculum. Arch Surg. 2009;144(1):77–82; discussion 82

    Article  PubMed  Google Scholar 

  75. Lin E, Szomstein S, Addasi T, Galati-Burke L, Turner JW, Tiszenkel HI. Model for teaching laparoscopic colectomy to surgical residents. Am J Surg. 2003;186(1):45–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Troupis, T.G., Michalinos, A., Skandalakis, G.P., Davidson, P.L., Mirilas, P., Skandalakis, P.N. (2021). Laparoscopic Colon Surgery: Education and Best Practices. In: Kouraklis, G., Matsiota, E.(. (eds) Laparoscopic Colon Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-56728-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-56728-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-56727-9

  • Online ISBN: 978-3-030-56728-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics