Skip to main content

Advertisement

SpringerLink
Log in

Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

While several procedural training curricula in laparoscopic colorectal surgery have been validated and published, none have focused on dividing surgical procedures into well-identified segments, which can be trained and assessed separately. This enables the surgeon and resident to focus on a specific segment, or combination of segments, of a procedure. Furthermore, it will provide a consistent and uniform method of training for residents rotating through different teaching hospitals. The goal of this study was to determine consensus on the key steps of laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy among experts in our University Medical Center and affiliated hospitals. This will form the basis for the INVEST video-assisted side-by-side training curriculum.

Methods

The Delphi method was used for determining consensus on key steps of both procedures. A list of 31 steps for laparoscopic right hemicolectomy and 37 steps for laparoscopic sigmoid colectomy was compiled from textbooks and national and international guidelines. In an online questionnaire, 22 experts in 12 hospitals within our teaching region were invited to rate all steps on a Likert scale on importance for the procedure.

Results

Consensus was reached in two rounds. Sixteen experts agreed to participate. Of these 16 experts, 14 (88 %) completed the questionnaire for both procedures. Of the 14 who completed the first round, 13 (93 %) completed the second round. Cronbach’s alpha was 0.79 for the right hemicolectomy and 0.91 for the sigmoid colectomy, showing high internal consistency between the experts. For the right hemicolectomy, 25 key steps were established; for the sigmoid colectomy, 24 key steps were established.

Conclusion

Expert consensus on the key steps for laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy was reached. These key steps will form the basis for a video-assisted teaching curriculum.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. van Det MJ, Meijerink WJHJ, Hoff C, Middel LJ, Koopal SA, Pierie JPEN (2011) The learning effect of intraoperative video-enhanced surgical procedure training. Surg Endosc 25(7):2261–2267. doi:10.1007/s00464-010-1545-5

    Article  PubMed Central  PubMed  Google Scholar 

  2. van Det MJ, Meijerink WJHJ, Hoff C, Middel B, Pierie JPEN (2013) Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training. Surg Endosc 27(8):2947–2954. doi:10.1007/s00464-013-2862-2

    Article  PubMed  Google Scholar 

  3. Palter VN, MacRae HM, Grantcharov TP (2011) Development of an objective evaluation tool to assess technical skill in laparoscopic colorectal surgery: a Delphi methodology. Am J Surg 201(2):251–259. doi:10.1016/j.amjsurg.2010.01.031

    Article  PubMed  Google Scholar 

  4. Bethlehem MS, Kramp KH, van Det MJ, ten Cate Hoedemaker HO, Veeger NJGM, Pierie JPEN (2014) Development of a standardized training course for laparoscopic procedures using Delphi methodology. J Surg Educ. doi:10.1016/j.jsurg.2014.04.009

    PubMed  Google Scholar 

  5. Dalkey NC (1969) The Delphi method: an experimental study of group opinion. RAND Corporation; Santa Monica, California

    Google Scholar 

  6. Graham B, Regehr G, Wright JG (2003) Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol 56:1150–1156. doi:10.1016/s0895-4356(03)00211-7

    Article  PubMed  Google Scholar 

  7. Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer. (2012) Written by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), reviewed and approved for endorsement by the Executive Council of the American Society of Colon and Rectal Surgeons (ASCRS) on 23 Feb 2012. http://www.sages.org/publications/guidelines/. Accessed June 2013

  8. Essential steps for intracorporeal right colectomy for neoplasia. (Year undisclosed) Prof Roberto Bergamaschi (Norway and Stonybrook Hospital New York). European Association for Endoscopic Surgery. http://www.eaes.eu/training/tips-and-tricks.aspx/. Accessed June 2013

  9. Neugebauer EAM, Sauerland S, Fingerhut A, Millat B, Buess G (2004) EAES Guidelines for Endoscopic Surgery, twelve years evidence-based surgery in Europe. EAES Clinical Practice Guidelines on Laparoscopic resection of Colonic Cancer. Springer, Berlin, pp 161–207

    Google Scholar 

  10. NVvH richtlijn colorectaal carcinoom. (2014) IKNL and KiMS. http://www.heelkunde.nl/kwaliteit/richtlijnen/richtlijnen-definitief. Accessed June 2013, updated May 2014

  11. Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Pigazzai A, Stamos MJ (2014) Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 57(2):179–186. doi:10.1097/DCR.0000000000000033

    Article  PubMed  Google Scholar 

  12. Cheung YM, Lange MM, Buunen M, Lange JF (2009) Current technique of laparoscopic total mesorectal excision (TME): an international questionnaire among 368 surgeons. Surg Endosc 23(12):2796–2801. doi:10.1007/s00464-009-0566-4

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the responding colorectal surgeons of the NESSN for their participation in the expert panel.

Disclosures

Frederieke A. Dijkstra, Robbert J.I. Bosker, Nicolaas J.G.M. Veeger, Marc J. van Det and Jean Pierre E.N. Pierie have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Groningen, University Medical Center Groningen, HPC BA31, P.O. box 30.001, 9700 RB, Groningen, The Netherlands

    Frederieke A. Dijkstra

  2. Department of Surgery, Deventer Hospital, Deventer, The Netherlands

    Robbert J. I. Bosker

  3. Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Nicolaas J. G. M. Veeger

  4. Department of Epidemiology, MCL Academy, Medical Center Leeuwarden, Leeuwarden, The Netherlands

    Nicolaas J. G. M. Veeger

  5. Leeuwarden Institute for Minimal Invasive Surgery, Leeuwarden, The Netherlands

    Marc J. van Det & Jean Pierre E. N. Pierie

  6. Department of Surgery, Hospital Group Twente, ZGT Almelo, Almelo, The Netherlands

    Marc J. van Det

  7. Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands

    Jean Pierre E. N. Pierie

  8. Post Graduate School of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Jean Pierre E. N. Pierie

Authors
  1. Frederieke A. Dijkstra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robbert J. I. Bosker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolaas J. G. M. Veeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc J. van Det
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean Pierre E. N. Pierie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederieke A. Dijkstra.

Additional information

On behalf of the expert panel of the North-East Surgical School of the Netherlands: G.I.J.M. Beerthuizen, Martini Hospital Groningen. E.B. van Duyn, Medisch Spectrum Twente. K. Havenga, University Medical Center Groningen. P.H.J. Hemmer, University Medical Center Groningen. Chr. Hoff, Medical Center Leeuwarden. H.S. Hofker, University Medical Center Groningen. F.W.H. Kloppenberg, Bethesda Hospital Hoogeveen. S.A. Koopal, Medical Center Leeuwarden. E.A. Kouwenhoven, Twenteborg Hospital. C. Krikke, University Medical Center Groningen. J.F.M. Lange, University Medical Center Groningen. J. Leijtens, Laurentius Hospital Roermond. E.J. Mulder, Antonius Hospital Sneek. V.B. Nieuwenhuijs, Isala Clinics Zwolle. E.G.J.M. Pierik, Isala Clinics Zwolle. R.A. Schasfoort, Scheper Hospital Emmen. G. Slooter, Maxima Medical Center. A.P.M. Stael, Martini Hospital Groningen. E. Totte, Medical Center Leeuwarden.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dijkstra, F.A., Bosker, R.J.I., Veeger, N.J.G.M. et al. Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology. Surg Endosc 29, 2620–2627 (2015). https://doi.org/10.1007/s00464-014-3979-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3979-7

Keywords

Search

Navigation