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World Journal of Surgery

, Volume 35, Issue 2, pp 409–414 | Cite as

Modular Training in Laparoscopic Colorectal Surgery Maximizes Training Opportunities without Clinical Compromise

  • Anil Hemandas
  • Karen G. Flashman
  • Jill Farrow
  • Daniel P. O’Leary
  • Amjad ParvaizEmail author
Article

Abstract

Background

Laparoscopic surgery is increasingly proposed as the gold standard technique for colorectal resections and is offered to greater numbers of patients. To meet the rising service demands, more trainees and established consultants need to learn the technique. We sought to establish whether it is feasible and safe to train on a large proportion of patients without adversely affecting clinical outcome or smooth running of clinical service.

Methods

Between September 2006 and July 2008, four senior trainees of the Wessex Specialist Registrar training rotation were involved in training in laparoscopic colorectal surgery. Major colorectal resections were separated into clearly defined modules for training purposes. Right and left hemicolectomies each comprised two modules, and low anterior resection comprised three modules. Prospective data on consecutive patients undergoing laparoscopic colorectal surgery were collected. Data included type of surgery, module of procedure performed by trainee or trainer, body mass index (BMI), conversion rates, median operative time, complications, length of hospital stay, and mortality.

Results

During the study period 227 colorectal resections were attempted laparoscopically. Of these, 216 (96%) proved suitable for training and 97% were completed laparoscopically. Some 23% of patients were American Society of Anesthesiologists score (ASA) ≥3; 35% had a BMI ≥28; 38% had a history of previous laparotomy. Trainees performed 96% (142/148) of right hemicolectomy modules, 99% (154/156) of left hemicolectomy modules, and 67% (128/192) of rectal resection modules. Each trainee was competent to do right and left hemicolectomy at the end of the training period. Four patients (2%) required further surgery for postoperative complications. Of the procedures completed by the trainees, 155/171 (91%) cancer resections were potentially surgically curative, and R0 resections were achieved in 99%. The readmission rate was 10% (22/216) and median length of hospital stay was 4 days. Postoperative mortality was zero.

Conclusions

Using a modular approach it is possible to provide effective training during almost all laparoscopic colorectal resections while achieving good clinical outcomes for the patients.

Keywords

Colorectal Resection Rectal Resection Cancer Resection Laparoscopic Colorectal Resection Laparoscopic Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
  2. 2.
    Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMedGoogle Scholar
  3. 3.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre randomised controlled trial. Lancet 365:1718–1726CrossRefPubMedGoogle Scholar
  4. 4.
    King PM, Blazeby JM, Ewings P et al (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308CrossRefPubMedGoogle Scholar
  5. 5.
    Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMedGoogle Scholar
  6. 6.
    http://www.alsgbi.org/. Accessed 6 March 2010
  7. 7.
    http://www.lapco.nhs.uk/. Accessed 6 March 2010
  8. 8.
    Tekkis PP, Senagore AJ, Delaney CP et al (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91CrossRefPubMedGoogle Scholar
  9. 9.
    Tekkis PP, Senagore AJ, Delaney CP (2005) Conversion rates in laparoscopic colorectal surgery: a predictive model with 1253 patients. Surg Endosc 19:47–54CrossRefPubMedGoogle Scholar
  10. 10.
    Pikarsky AJ, Saida Y, Yamaguchi T et al (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858CrossRefPubMedGoogle Scholar
  11. 11.
    Arteaga Gonzalez I, Martin Malagon A et al (2006) Impact of previous abdominal surgery on colorectal laparoscopy results: a comparative clinical study. Surg Laparosc Endosc Percutan Tech 16:8–11CrossRefPubMedGoogle Scholar
  12. 12.
    Lund L, Dubrowski A, Carnahan H (2007) A modular approach for training urologists in laparoscopy. BJU Int 100:1216–1218CrossRefPubMedGoogle Scholar
  13. 13.
    Stolzenburg JU, Schwaibold H, Bhanot SM et al (2005) Modular surgical training for endoscopic extraperitoneal radical prostatectomy. BJU Int 96:1022–1027CrossRefPubMedGoogle Scholar
  14. 14.
    Bonatti J, Schachner T, Bernecker O et al (2004) Robotic totally endoscopic coronary artery bypass: program development and learning curve issues. J Thorac Cardiovasc Surg 127:504–510CrossRefPubMedGoogle Scholar
  15. 15.
    Marks JH, Kawun UB, Hamdan W et al (2008) Redefining contraindications to laparoscopic colorectal resection for high-risk patients. Surg Endosc 22:1899–1904CrossRefPubMedGoogle Scholar
  16. 16.
    Buchanan GN, Malik A, Parvaiz A et al (2008) Laparoscopic resection for colorectal cancer. Br J Surg 95:893–902CrossRefPubMedGoogle Scholar
  17. 17.
  18. 18.
  19. 19.
    Renwick AA, Bokey EL, Chapuis PH (2005) Effect of supervised surgical training on outcomes after resection of colorectal cancer. Br J Surg 92:631–636CrossRefPubMedGoogle Scholar
  20. 20.
    Ganzer R, Rabenalt R, Truss MC et al (2008) Evaluation of complications in endoscopic extraperitoneal radical prostatectomy in a modular training programme: a multicentre experience. World J Urol 26:587–593CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Anil Hemandas
    • 1
  • Karen G. Flashman
    • 1
  • Jill Farrow
    • 1
  • Daniel P. O’Leary
    • 1
  • Amjad Parvaiz
    • 1
    Email author
  1. 1.Department of Colorectal SurgeryNational Centre for Training in Laparoscopic Colorectal Surgery, Queen Alexandra HospitalPortsmouthUK

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