Abstract
Colorectal surgery has been revolutionised towards minimally invasive surgery with the emergence of enhanced recovery protocol after surgery initiatives. However, laparoscopic colectomy has yet to be widely adopted, due mainly to the steep learning curve. We aim to review and discuss the methods of overcoming these learning curves by accelerating the competency level of the trainees without compromising patient safety. To provide this mini review, we assessed 70 articles in PubMed that were found through a search comprised the keywords laparoscopic colectomy, minimal invasive colectomy, learning curve and surgical education. We found England’s Laparoscopic Colorectal National Training Programme (LAPCO-NTP) England to be by far the most structured programme established for colorectal surgeons, which involves pre-clinical and clinical phases that end with an assessment. For budding colorectal trainees, learning may be accelerated by simulator-based training to achieve laparoscopic dexterity coupled with an in-theatre proctorship by field experts. Task-specific checklists and video recordings are essential adjuncts to gauge progress and performance. As competency is established, careful case selections with the proctor are essential to maintain motivation and ensure safe performances. A structured programme to establish competency is vital to help both the proctor and trainee gauge real-time progress and performance. However, training systems both inside and outside the operating theatre (OT) are equally useful to achieve the desired performance.
Highlights
Global population growth and ageing, along with the rising frequency of colorectal cancer (CRC) in the younger population, has added to the already existent burden on the healthcare system [1–5]
Laparoscopic colectomy for CRC emerged in the early 1990s [8]
Despite early reservations about applying laparoscopic techniques in colonic oncological resection, adequate evidence has been produced to show that laparoscopic colectomy produces similar oncological outcomes to open colectomy [9–12]
Summary
Global population growth and ageing, along with the rising frequency of colorectal cancer (CRC) in the younger population, has added to the already existent burden on the healthcare system [1–5]. Only 30% of colectomies are performed laparoscopically in England and Australia, while countries like South Korea, Japan and Singapore have reported that 60% of CRC cases employ MIS [20, 21]. The most appropriate means of measuring learning would be improvements in case-adjusted long-term survival Such determinations require a long period of data collection before an analysis can be conducted. The reported number of cases needed to achieve competency ranges from 11 to 117 (Table 1) Most of these learning curve studies have used operative time and the rate of conversion as the yardsticks to assess progress in surgical skill performance. By selecting the appropriate patient or case for the perceived skill level along with supervision by experienced trainers, a trainee should be able to safely hasten progress along the learning curve [29, 32–38]
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