ORIGINAL REPORTSStepwise Training in Laparoscopic Surgery for Complex Ileocolonic Crohn's Disease: Analysis of 127 Training Episodes
Section snippets
INTRODUCTION
The advent of laparoscopic surgery has dramatically changed the landscape of colorectal surgery for both benign and malignant disease. Laparoscopy offers well-described benefits1 such as decreased pain, lower wound complication rates, improved pulmonary function, earlier resumption of diet and bowel function, better cosmesis and shorter hospital stay2 when compared to open surgery.
However, widespread use of laparoscopy in Crohn's disease (CD) has been more limited due to technical constraints:
Study Settings
All patients undergoing laparoscopic surgery for penetrating or recurrent ileocolonic CD from January 2017 to December 2018 were included in this prospective observational study. Patients undergoing open, single-incision, robotic or hand-assisted surgery were excluded as were patients undergoing emergency operations. The indication for surgical resection was discussed at a dedicated inflammatory bowel disease multidisciplinary team meeting involving gastroenterologists, colorectal surgeons,
RESULTS
One hundred and twenty-seven training episodes were included and 86 were performed by trainees (67.7%). 48 tasks (37.8%) involved penetrating CD with fistula formation, while the remaining 79 included redo surgery for recurrent CD (62.2%). Junior trainees only performed 41 of the 72 tasks they were involved in (56.9%), while senior trainees performed 46 out of 55 tasks (83.6%) p < 0.0001.
Fistula division was the less commonly performed training episode (25%), while mobilisation and anastomosis
DISCUSSION
Despite the benefits of laparoscopic surgery,16 a considerable number of CD patients may be a formidable challenge even for the most experienced laparoscopic surgeon,17 who also has to be prepared to deal with unexpected findings that may require additional surgery, such as proximal strictures, fistulas, abscesses, or phlegmons, which can be identified in about 20% of patients.18 Surgery for CD is technically challenging and the perioperative decision making of when to operate and whether to
CONCLUSIONS
A stepwise training approach can be applied to laparoscopic surgery for complex Crohn's disease with a high rate of tasks successfully performed by supervised trainees and an acceptable profile of postoperative outcomes.
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Cited by (4)
Standardization of ileoanal J-pouch surgery technique: Quality assessment of minimally invasive ileoanal J-pouch surgery videos
2022, Surgery (United States)Citation Excerpt :Despite this, our study highlights the need for standardization of IPAA surgery, which could be enhanced by a Delphi process promoted by surgical societies, but also the need for quality control of IPAA surgery that must start from international registries reporting on key performance indicators. Our results advocate for the role of surgical videos review as an additional tool to enhance training in complex surgery34 and accreditation in low-volume procedures, as gaining experience in pouch surgery is often difficult since the procedure is performed infrequently. This is evident from the UK Pouch Registry,35 reporting that the average number of pouches performed in English institutions was just 3 cases per year, and one-quarter of the pouch surgeons undertaking this surgery had performed only 1 case over the last 5 years.
How can surgical skills in laparoscopic colon surgery be objectively assessed?—a scoping review
2022, Surgical EndoscopySurgical treatment of colonic Crohn’s disease: a national snapshot study
2021, Langenbeck's Archives of Surgery
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