Support provided in the form of an educational grant.
Although rates of elective laparoscopic colectomy (LC) increased significantly in Canada in the last decade, there is still room for improvement. Substantial variation in use of LC also exists across the country. Established community surgeons face significant challenges to adopting LC, such as lack of formal training in advanced laparoscopic surgery, difficulty finding a suitable mentor and an institutional culture resistant to change.
The CAGS Minimally Invasive Surgery Committee developed the Masters Laparoscopic Colectomy Program (MLCP), based on the highly successful National Training Program (NTP) of the United Kingdom. The goal of the MLCP is to support established surgeons interested in incorporating / advancing laparoscopic colectomy in their practices, to the point where they are comfortable performing these procedures safely and independently. The program consists of a one-day course that includes both didactic sessions and a hands-on cadaver lab focused on laparoscopic right and left colectomy, followed by longitudinal, 1-on-1 mentorship tailored to each trainee’s needs.
Laparoscopic colorectal surgery
Compared to open colectomy, LC enhances postoperative recovery including earlier mobilization and resolution of ileus, less postoperative pain and shorter length of hospital stay, whilst providing equivalent 3- and 5-year disease-free and overall survival when performed for cancer.
Development of the Masters Laparoscopic Colectomy Program
Given the evidence from randomized controlled trials on the advantages of laparoscopic vs. open colectomy, the Department of Health in the United Kingdom (UK) published guidelines in 2006 that required LC be available to all patients who qualified for it. However, it realized the need for a comprehensive NTP since only 5% of colorectal surgeons at the time were trained in laparoscopic colectomy. The NTP was designed to address the long learning curve of self-taught LC, which often came at the expense of patient safety, by implementing structured, supervised training.
The MLCP is moulded on the NTP. It consists of 3 phases: Precourse assessment / candidate selection, a 1- day didactic and cadaver course and post-course mentorship. The latter includes observation and supervision with 1-on-1 expert intraoperative training. A validated formative Global Assessment Score (GAS) is completed by trainer and trainee after each supervised case. When both trainer and trainee feel comfortable that the trainee can safely and competently perform LC the trainee submits 2 unedited videos for independent, blinded assessment by use of a validated Competency Assessment Tool (CAT). If both videos are passed the trainee is signed off as having successfully completed the program. The trainee is required to report clinical and oncological outcomes for 1 year after sign-off.
LAPCO Train the Trainer
By 2007 the UK Dept. of Health realized the need to improve, standardize and benchmark the quality of training delivered within the NTP. As such, it developed the Lapco Train the Trainer course. The curriculum consists of a learner-focused teaching structure that emphasizes 3 phases: 1) Preoperative alignment of trainer and trainee agendas and setting training objectives, 2) Intraoperative performance-enhancing instruction and 3) Postoperative structured feedback. As with the NTP, all trainers in the MLCP are required to have completed the Lapco Train the Trainer course.
CAGS would very much welcome surgeons experienced in laparoscopic colectomy who are interested in becoming Lapco-certified and joining our MLCP faculty.
Masters Course, 2019
The first CAGS Masters course took place on Sunday, September 8, 2019 following the Canadian Surgery Forum in Montreal, QC. The 1-day course focused on the technical aspects of laparoscopic right and left hemicolectomy and included a didactic component and cadaver lab. It was followed by a mentorship period, to which all trainees have been assigned.
Selection criteria for trainees included:
- Ability to perform basic laparoscopic procedures, such as cholecystectomy and appendectomy
- Adequate colectomy volume
- Availability of equipment required for advanced laparoscopy
- Trainee expressed desire to enter into a Trainee/Mentor relationship
- Trainee showed motivation to learn and implement new skills
Currently planning is under way for the second Masters Course to be hosted in 2020. Potential attendees are welcome to apply.
Dr. Marius Hoogerboord, Halifax, NS (Course co-director)
Dr. Sami Chadi, Toronto, ON (Course co-director)
Dr. Fayez Quereshy, Toronto, ON
Dr. Kevin Lefevbre, Stratford, ON
Dr. Carl Brown, Vancouver, BC
Dr. Ryan Snelgrove, Edmonton, AB
Dr. Marylise Boutros, Montreal, QC
Dr. Leanne Wood
Dr. Mylene Ward
Dr. Ryan Kelly
Dr. David McFarlane
Dr. Omar Hassan
Dr. Wasseem Moussa
Dr. Miriam Rana
Dr. Amith Mulla
Dr. Michelle Nostedt
Dr. Sonna Dhalla
CAGS’ First LAPCO Train the Trainer Session
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