A tool-kit for the quantitative assessment of proficiency in laparoscopic colorectal surgery

Shah, PR; Haray, P. N.

doi:10.1111/j.1463-1318.2010.02204.x

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…However, they are still accruing data on long term oncological outcomes. Laparoscopic TME can be technically challenging and should be undertaken by experienced surgeons[12,20-22]. Caution should therefore be exercised when evaluating results of laparoscopic TME when the expertise of the surgeons has not been defined.…”

Section: Discussionmentioning

confidence: 99%

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Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Rao¹,

Peiris²,

Arif³

et al. 2017

WJGS

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AIMTo assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers.METHODSWe undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTSFollowing appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases.CONCLUSIONManagement of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.

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Section: Discussionmentioning

confidence: 99%

“…We defined conversion as previously published[12]: (1) If the final incision made was longer than planned pre-operatively; (2) If the incision needed to be made at an earlier stage of the operation than planned pre-operatively; and (3) If the incision was made at a site other than that planned pre-operatively.…”

Section: Methodsmentioning

confidence: 99%

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Rao¹,

Peiris²,

Arif³

et al. 2017

WJGS

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“…[ 3 ] This percentage is variable however with some centres reporting figures as high as 90% for elective laparoscopic colorectal resections. [ 4 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…Hence, traditional indicators such as the number of cases operated, conversion rates, mortality and morbidity are not reliable indicators for the assessment of competence. [ 5 12 ] The programme described in this paper has the flexibility to offer subsequent visits by the preceptor as and when the preceptee starts undertaking more complex cases and indeed, some of the preceptees in this series have already requested a ‘second round’ of preceptorship. The most important aspect of this programme is that training is not continuous but intermittent.…”

Section: Discussionmentioning

confidence: 99%

A structured preceptorship programme for laparoscopic colorectal surgery in Wales: An early experience

et al. 2014

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INTRODUCTION:A single experienced laparoscopic colorectal surgeon introduced an outreach preceptorship programme (OPP) for laparoscopic colorectal surgery (LCS) in Wales with the aim of supporting consultants in the early stages of their learning curve, as well as to help avoid some of the problems faced by self-taught laparoscopic surgeons. The structured programme consisted of a minimum 1 day master class at the preceptor's operating theatre, followed by multiple outreach visits by the preceptor. The aim of this study was to evaluate the effectiveness and early experience of this programme.MATERIALS AND METHODS:Clinical end-points (conversions, morbidity/mortality and length of hospital stay) were analysed from a prospectively maintained database. Evaluation of the programme was based on interviews with the preceptee surgeons performed by a neutral observer.RESULTS:Between May 2008 and July 2010, 11 Consultants (six hospitals) were preceptored (two still in programme). 66 cases (20 in the master class, 46 as an outreach service) were performed as a part of this programme. Clinical outcome: Conversion rate and 30-day mortality was 1.5%. Morbidity was reported at 12% (8/66) and median length of stay was 6 days. Programme evaluation: All interviewed respondents found the master class and outreach service to be well-organised and would recommend it to their colleagues. The median number of outreach visits per hospital was 5. All the preceptees have performed independent cases since the programme.CONCLUSION:This OPP delivers one-to-one coaching at the point of service delivery and has been shown to be effective in achieving safe transference of skills to those wishing to develop a service for LCS.

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Enhanced recovery after colorectal surgery: principles and current practice

Rao

Haray

2014

Surgery (Oxford)

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A tool-kit for the quantitative assessment of proficiency in laparoscopic colorectal surgery

Abstract: The results show that it is possible to quantify the workload in laparoscopic colorectal surgery and to assess increasing proficiency using a simple, reproducible and reliable tool-kit.

Cited by 3 publications

References 17 publications

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

A structured preceptorship programme for laparoscopic colorectal surgery in Wales: An early experience

Enhanced recovery after colorectal surgery: principles and current practice

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