Abstract
Objective
To demonstrate the feasibility of longitudinal mentoring and telementoring of community surgeons in laparoscopic colon surgery.
Methods
A mentoring protocol was established between a university centre and surgeons at a community hospital 60 km away. The community surgeons (CS) attended a course on laparoscopic colon surgery before observing surgery at the mentoring institution. Patients were identified from the CS practice and referred for formal consultation with the mentor. The mentor worked with the same two CS on every case in their local hospital. Procedure outcomes were recorded using Canadian Advanced Endoscopic Surgery Registry (CAESaR) practice audit software. The mentoring endpoint was 20 cases based on American Society of Colon and Rectal Surgeons (ASCRS)/Society of Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines.
Results
From March 2006 to August 2007, 40 patients underwent elective colon surgery by the CS, 20 of whom were referred and accepted for laparoscopic mentoring. After nine cases the MS did not scrub. Beginning with case 15, procedures were telementored except for a subtotal colectomy for which the MS assisted. Patients selected for mentoring (7 female, 13 male) compared with open cases (8 female, 12 male) were younger (60 ± 13 years versus 72 ± 17 years, p = 0.013), less likely to have cancer (50% versus 70%, p = 0.33)) and tended to require less complex resections. There were no conversions. Mentored cases took longer (150 ± 43 min versus 108 ± 40 min, p = 0.003) but resulted in shorter hospital stay (median 2.5 versus 7.0 days, p < 0.001). Median number of lymph nodes were equivalent in cancer resections (13 versus 12, p = 0.465) There were no technical difficulties with telementoring. Data will be recorded for a further 1 year to assess adoption rate and outcomes.
Conclusions
This project demonstrates the feasibility of longitudinal mentoring and telementoring of laparoscopic colon surgery for cancer. This program may serve as a model for safe technology transfer to the community.
Similar content being viewed by others
References
Fowler DL, White SA (1991) Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1:183–188
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopic assisted and open colectomy for colon cancer. NEJM 350(20):2050–2059
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoint of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484
Laparoscopic Colectomy for Curable Cancer (2004) Available at http://www.fascrs.org/physicians/position_statements/laparoscopic_colectomy. June 2004; Accessed 5 April 2008
Smith A, Rumble RB, Langer B, Stern H, Schwartz F, Brouwers M, and members of Cancer Care Ontario’s Laparoscopic Colon Cancer Surgery Expert Panel and Program in Evidence-based Care (2005) Laparoscopic Surgery for Cancer of the Colon. Available at http://www.cancercare.on.ca/pdf/pebc2-20-2s.pdf. September 2002; Accessed 5 April 2008
Chiasson PM, Pace DE, Schlachta CM, Mamazza J, Poulin EC (2004) Minimally invasive surgical practice: a survey of general surgeons in Ontario. Can J Surg 47(1):15–19
Birch DW, Misra M, Farrokhyar F (2007) The feasibility of introducing advanced minimally invasive surgery into surgical practice. Can J Surg 50(4):256–260
Birch DW, Asiri AH, de Gara CJ (2007) The impact of a formal mentoring program for minimally invasive surgery on surgeon practice and patient outcomes. Am J Surg 193(5):589–591
Guidelines for Institutions Granting Privileges Utilizing Laparoscopic and/or Thoracoscopic Techniques (2001) Available at http://www.sages.org/publications/publication.php?id=14. June 2001; Accessed 5 April 2008
Heniford BT, Backus CL, Matthews BD, Greene FL, Teel WB, Sing RF (2001) Optimal teaching environment for laparoscopic splenectomy. Am J Surg 181(3):226–230
Heniford BT, Matthews BD, Box EA, Backus CL, Kercher KW, Greene FL, Sing RF (2002) Optimal teaching environment for laparoscopic ventral herniorrhaphy. Hernia 6(1):17–20
Rosser JC Jr, Young SM, Klonsky J (2007) Telementoring: an application whose time has come. Surg Endosc 21(8):1458–1463
Fleshman J, Marcello P, Stamos MJ, Wexner SD (2006) 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): guidelines for laparoscopic colectomy course. Surg Endosc 20(7):1162–1167
Acknowledgements
The authors are grateful to Dave Browning of CSTAR for his expertise and assistance developing the telementoring link between institutions. This project was financially supported by Ethicon Endosurgery, a division of Johnson & Johnson Medical Products, Markham, Ontario.
Author information
Authors and Affiliations
Corresponding author
Additional information
This paper was an oral presentation on April 11, 2008 at SAGES, Philadelphia, PA.
An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-009-0444-0
Rights and permissions
About this article
Cite this article
Schlachta, C.M., Kent, S.A., Lefebvre, K.L. et al. A model for longitudinal mentoring and telementoring of laparoscopic colon surgery. Surg Endosc 23, 1634–1638 (2009). https://doi.org/10.1007/s00464-008-0221-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0221-5