developments in laparoscopic colorectal surgery. technology appraisal ta105 both laparoscopic and...
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Developments in Laparoscopic Colorectal
Surgery
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Technology appraisal TA105
• Both laparoscopic and open surgery are suitable for the person and their condition
• Their surgeon has been trained in laparoscopic surgery for colorectal cancer and performs the operation often enough to keep his or her skills up to date
Recommends laparoscopic surgery as an alternative to open surgery for people with colorectal cancer if:
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CSCG3rd Bowel Cancer ReportApr 2005 – March 2007
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History of programme
• DoH and Cancer Action Team provide money for England
• Sept 2007• 3 preceptors in Wales• WAG agreed funding on
scheme administered from WIMAT
• 29 Aug 08 appointed Lead Wales
• 23 Sept 08 New Lead England
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Multiple reservations
• Too prescriptive• Credentialling /
Accrediation• 5 or 10 years too late• Resentment about
equipment• Multiple new appointments• Existing training schemes
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Aims of the programme
• Ensure that all patients suitable for laparoscopic colorectal cancer resection have access to the choice
• Ensure a legacy of laparoscopic colorectal training in Wales
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Questionnaire 45 colorectal surgeons
Abdullah Appleton Arun Beynon Bhowmick Billings Carr Chamery Davies(1) Davies(2) Delicata Edwards Foster Ghopal Haray Hargest Harries Jackson Jamison Joseph Khot Lala Marsh Masoud Maw McKain Milewski Morgan Phillips Pritchard Radcliffe Rees Rowley Sekeran Shami Shanahan Sheridan Stephenson Swankar Torkington Umughele Whiteley Williams Woodward Young
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127%
211%3
40%
422%
36/45 80% response rate
no plans to start
want to startoff and running
ready to teach
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4
3
12
24
31
12
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Should be part of MDT discussion?
• Yes 26/37 70%• No 5/37
14%• No answer 6/37
16%
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What % patients realistically are suitable?
0
2
4
6
8
10
12
14
16
18
<10% 10-50% 50-75% >75%
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Barriers to offering more lap surgery to your patients?
02468
10121416
Tim
e
Equip
men
t
Trai
ning/
conf
iden
ce
Patien
t co-
mor
bidity
Other
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Current Consultants
Teams
Future Consultants
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Current Consultants
• Bespoke training/support• Non threatening• Not accreditation
• Courses• Coordinating preceptorship• Own hospital or host
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Team training
• Anaesthetist• Scrub nurses• Access to integrated
theatre system• Oesophageal doppler• Support group
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Future consultants
• Self sufficient in Wales for training
• Expect laparoscopic colorectal training by CCST
• “Technique not a speciality”
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BSS Course
Core skills Laparoscopy
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BSS Course
Core skills Laparoscopy
AppendixRight Hemi
Left side Resection
Animal Lab
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BSS Course
Core Skills Laparoscopy
AppendixRight Hemi
Left Side Resection
Animal Lab
CT1/2
ST3/4
ST 5/6
ST 7/8
Colorectal
Trainee
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Coordination
Administration
ContactKate Creighton
Griffiths02920 71682128Creighton-
Teaching Faculty
Incl. audit
RITA committee