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Objective assessment of minimally invasive total mesorectal excision performance: a systematic review

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Abstract

Introduction

Laparoscopy is widely used in colorectal practice, but recent trial results have questioned its use in rectal cancer resections. Patient outcomes are directly linked to the quality of total mesorectal excision (TME) specimen. Objective assessment of intraoperative performance could help ensure competence and delivery of optimal outcomes. Objective tools may also contribute to TME intervention trials, but their nature, structure and utilisation is unknown.

Aim

To systemically review the available literature to report on the available tools for the objective assessment of minimally invasive TME operative performance and their use within multicentre laparoscopic TME randomised controlled trials.

Methods

A systematic search of the PubMed and Cochrane databases was performed to identify tools used in the objective intraoperative assessment of minimally invasive TME performance in accordance with the PRISMA guidelines, independently by two authors. The identified tools were then evaluated within reported TME RCTs.

Results

A total of 8642 abstracts were screened of which 12 papers met the inclusion criteria; ten prospective observational studies, one randomised trial and one educational consensus. Eight assessment methods were described, which include formative and summative tools. The tools were mostly adaptations of colonic surgery tools based on either operative video review or post-operative trainer rating. All studies reported objective assessment of intraoperative performance was feasible, but only 126 (7%) of the 1762 included laparoscopic cases were TME. No multicentre laparoscopic TME trial reported using any objective surgical performance assessment tool.

Conclusion

Objective intraoperative laparoscopic TME performance assessment is feasible, but most of the current tools are adaptation of colonic surgery. There is a need to develop dedicated assessment tools for minimal access rectal surgery. No multicentre minimally invasive TME RCT reported using any objective assessment tool.

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Author information

Authors and Affiliations

  1. Clinical Research Unit, Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 4AT, UK

    N. J. Curtis, J. Davids, J. D. Foster & N. K. Francis

  2. Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, Praed Street, London, UK

    N. J. Curtis & J. D. Foster

  3. Faculty of Science, University of Bath, Wessex House 3.22, Bath, Somerset, UK

    N. K. Francis

Authors
  1. N. J. Curtis
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  2. J. Davids
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  4. N. K. Francis
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Corresponding author

Correspondence to N. K. Francis.

Ethics declarations

Conflicts of interest

Mr Curtis, Dr Davids, Mr Foster and Prof. Francis confirm they hold no conflicts of interest or financial disclosures.

Ethical approval

A formal ethical approval was not required for this evidence synthesis study. However, this research project was approved by the local governance of good clinical practice (GCP) according to the National Institute for Heath Research (NIHR)- UK.

Informed consent

No informed consent was required for this evidence synthesis study confined to a systematic review of published papers.

Appendix: Search string

Appendix: Search string

Minimally invasive

laparoscopic.tw OR laparoscope.tw OR laparoscopy.tw OR keyhole.tw OR minimally invasive.tw OR minimally-invasive.tw OR robotic.tw OR robot.tw OR robot assisted.tw OR stereoscopic.tw OR SILS.tw OR single incision.tw OR single-incision.tw OR stereoscope.tw OR 3D.tw OR three dimensional.tw OR three-dimensional.tw OR NOTES.tw

Total mesorectal excision

TME.tw OR total mesorectal excision.tw. OR mesorectal.tw OR rectal cancer.tw OR anterior resection.tw OR anterior-resection.tw OR TaTME.tw OR Trans-anal TME.tw OR colorectal.tw OR colo-rectal.tw. OR colo-rectal cancer.tw OR colorectal cancer.tw OR CRC.tw OR bowel resect$.tw OR rect$.tw OR proctectomy.tw

Assessment of performance

performance.tw OR assessment.tw OR objective.tw OR technical.tw OR procedural.tw OR competenc$.tw OR credent$.tw OR skill.mp OR proficiency.tw OR judgement.tw OR ability.tw OR training.tw OR education.tw OR analysis.tw OR developement.tw OR task.tw OR tool.tw OR error.tw OR proforma.tw OR score.tw OR checklist.tw OR global.tw OR evaluation.tw OR validity.tw OR observational.tw

  1. (((“laparoscopy”[MeSH Terms] OR “laparoscopy”[All Fields] OR “laparoscopic”[All Fields]) OR (“laparoscopes”[MeSH Terms] OR “laparoscopes”[All Fields] OR “laparoscope”[All Fields]) OR (“laparoscopy”[MeSH Terms] OR “laparoscopy”[All Fields]) OR keyhole[All Fields] OR (minimally[All Fields] AND invasive[All Fields]) OR minimally-invasive[All Fields] OR (“robotics”[MeSH Terms] OR “robotics”[All Fields] OR “robotic”[All Fields]) OR robot[All Fields] OR (robot[All Fields] AND assisted[All Fields]) OR stereoscopic[All Fields] OR (“squamous intraepithelial lesions of the cervix”[MeSH Terms] OR (“squamous”[All Fields] AND “intraepithelial”[All Fields] AND “lesions”[All Fields] AND “cervix”[All Fields]) OR “squamous intraepithelial lesions of the cervix”[All Fields] OR “sils”[All Fields]) OR ((“single person”[MeSH Terms] OR (“single”[All Fields] AND “person”[All Fields]) OR “single person”[All Fields] OR “single”[All Fields]) AND incision[All Fields]) OR single-incision[All Fields] OR stereoscope[All Fields] OR 3D[All Fields] OR (three[All Fields] AND dimensional[All Fields]) OR three-dimensional[All Fields] OR (“Notes Czechoslov Med Assoc G B”[Journal] OR “notes”[All Fields])) AND (TME[All Fields] OR (total[All Fields] AND mesorectal[All Fields] AND excision[All Fields]) OR mesorectal[All Fields] OR (“rectal neoplasms”[MeSH Terms] OR (“rectal”[All Fields] AND “neoplasms”[All Fields]) OR “rectal neoplasms”[All Fields] OR (“rectal”[All Fields] AND “cancer”[All Fields]) OR “rectal cancer”[All Fields]) OR (anterior[All Fields] AND resection[All Fields]) OR anterior-resection[All Fields] OR tatem[All Fields] OR (trans-anal[All Fields] AND tme[All Fields]) OR colorectal[All Fields] OR colo-rectal[All Fields] OR (“colorectal neoplasms”[MeSH Terms] OR (“colorectal”[All Fields] AND “neoplasms”[All Fields]) OR “colorectal neoplasms”[All Fields] OR (“colo”[All Fields] AND “rectal”[All Fields] AND “cancer”[All Fields]) OR “colo rectal cancer”[All Fields]) OR (“colorectal neoplasms”[MeSH Terms] OR (“colorectal”[All Fields] AND “neoplasms”[All Fields]) OR “colorectal neoplasms”[All Fields] OR (“colorectal”[All Fields] AND “cancer”[All Fields]) OR “colorectal cancer”[All Fields]) OR CRC[All Fields] OR (“administration, rectal”[MeSH Terms] OR (“administration”[All Fields] AND “rectal”[All Fields]) OR “rectal administration”[All Fields] OR “rectal”[All Fields]) OR (“rectum”[MeSH Terms] OR “rectum”[All Fields]) OR proctectomy[All Fields])) AND (performance[All Fields] OR (“Assessment”[Journal] OR “assessment”[All Fields]) OR (“goals”[MeSH Terms] OR “goals”[All Fields] OR “objective”[All Fields]) OR technical[All Fields] OR procedural[All Fields] OR (“mental competency”[MeSH Terms] OR (“mental”[All Fields] AND “competency”[All Fields]) OR “mental competency”[All Fields] OR “competence”[All Fields]) OR (“mental competency”[MeSH Terms] OR (“mental”[All Fields] AND “competency”[All Fields]) OR “mental competency”[All Fields] OR “competency”[All Fields]) OR (“credentialing”[MeSH Terms] OR “credentialing”[All Fields] OR “credential”[All Fields]) OR (“credentialing”[MeSH Terms] OR “credentialing”[All Fields]) OR skill[All Fields] OR proficiency[All Fields] OR (“judgment”[MeSH Terms] OR “judgment”[All Fields] OR “judgement”[All Fields]) OR (“aptitude”[MeSH Terms] OR “aptitude”[All Fields] OR “ability”[All Fields]) OR (“education”[Subheading] OR “education”[All Fields] OR “training”[All Fields] OR “education”[MeSH Terms] OR “training”[All Fields]) OR (“education”[Subheading] OR “education”[All Fields] OR “educational status”[MeSH Terms] OR (“educational”[All Fields] AND “status”[All Fields]) OR “educational status”[All Fields] OR “education”[All Fields] OR “education”[MeSH Terms]) OR (“analysis”[Subheading] OR “analysis”[All Fields]) OR (“growth and development”[Subheading] OR (“growth”[All Fields] AND “development”[All Fields]) OR “growth and development”[All Fields] OR “development”[All Fields]) OR task[All Fields] OR tool[All Fields] OR error[All Fields] OR proforma[All Fields] OR score[All Fields] OR (“checklist”[MeSH Terms] OR “checklist”[All Fields]) OR (“Glob Impacts”[Journal] OR “global”[All Fields]) OR (“evaluation studies”[Publication Type] OR “evaluation studies as topic”[MeSH Terms] OR “evaluation”[All Fields]) OR validity[All Fields] OR observational[All Fields]) AND ((“1982/01/01”[PDAT]: “2015/12/14”[PDAT]) AND English[lang])

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Curtis, N.J., Davids, J., Foster, J.D. et al. Objective assessment of minimally invasive total mesorectal excision performance: a systematic review. Tech Coloproctol 21, 259–268 (2017). https://doi.org/10.1007/s10151-017-1614-z

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