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

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

A Structured Modular Approach: The Answer to Training in Laparoscopic Colorectal Surgery

Bakground: Laparoscopic techniques are now an integral part of the operative management of colorectal diseases. However, the specialist training that is required for this is not uniformly available. There is, therefore, a need for a structured competency-based training method so that trainees can navigate the learning curve safely. Aim. To develop a modular structured training programme for laparoscopic colorectal surgery (LCS) with the capability of ensuring competency-based progression from a novice level to independent operator. Methodology. Over the past decade, we have developed a structured approach, starting with junior surgical trainees and progressing through to consultant level, with 7 clearly defined levels of progression attending courses to achieving a trainer status. This approach allows trainees to maintain objective records of their progression and trainers to provide targeted learning opportunities. It also allows for several trainees of varying experience to be trained during the same procedure. Conclusion. Our structured training module for junior surgeons has successfully produced several competent laparoscopic colorectal surgeons in the United Kingdom and around the world. This approach may also be adaptable to training in other laparoscopic procedures as the levels of progression are generic and not procedure-specific.</jats:p

Global treatment of haemorrhoids—A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons

Aim: There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. Methods: The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. Results: The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I–IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids – with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. Conclusion: Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed