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.
MIS Pathway
CAGS welcomes interest from surgeons experienced in laparoscopic colectomy who wish to become LAPCO-certified and join our MLCP faculty.
Please reach out to learn@cags-accg.ca if you are interested in applying.
Masters Laparoscopic Colectomy Program Sessions
Our next Master Course has yet to be scheduled.
Please reach out to learn@cags-accg.ca with expressions of interest or questions about the program.
The 2024 Masters Course was held February 9 at the Steinberg Centre for Simulation and Interactive Learning, McGill University.
The program consisted of a one-day course that included both didactic sessions and a hands-on cadaver lab focused on laparoscopic right and left colectomy, followed by an online proctorship and longitudinal 1-on-1 mentorship tailored to each trainee’s needs.
2024 Faculty
Dr. Marius Hoogerboord
Dr. Carl Brown
Dr. Sami Chadi
Dr. Kevin Lefebvre
Dr. Richard Spence
Trainees
Participants in the 2024 MLCP were welcomed to Montreal from across the country. Upon returning to their communities, surgeons are being supported by the faculty in their remote surgical mentorship through the use of live direct-link video assessment while performing LAPCO surgery.
Sponsor
CAGS acknowledges the generous support of:
Ethicon, who provided in-kind support to facilitate the in-person session and an educational grant to facilitate the remote mentorship portion of the program.
Stryker, who provided financial and in-kind support to facilitate the in-person training session.
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
2019 Faculty
Dr. Marius Hoogerboord, Halifax, NS (Course Director)
Dr. Sami Chadi, Toronto, ON
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
Masterclass Trainees
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
Development of the Masters Laparoscopic Colectomy Program
The NTP
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.
Supporting Evidence
- Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002 Jun 29;359(9325):2224-9.
- Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer Abstracted from: Nelson H, Sargent D, Wieand HS, et al; for the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050-2059. Cancer Treat Rev. 2004 Dec;30(8):707-9.
- Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005 May 14-20;365(9472):1718-26.
- Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005 Jul;6(7):477-84.
- Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003432. doi(2):CD003432.
- Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ. Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg. 2012 Mar;203(3):353,5; discussion 355-6.
- Feroci F, Kroning KC, Lenzi E, Moraldi L, Cantafio S, Scatizzi M. Laparoscopy within a fast-track program enhances the short-term results after elective surgery for resectable colorectal cancer. Surg Endosc. 2011 Sep;25(9):2919-25.
- Lee L, Wong-Chong N, Kelly JJ, Nassif GJ, Albert MR, Monson JRT. Minimally invasive surgery for stage III colon adenocarcinoma is associated with less delay to initiation of adjuvant systemic therapy and improved survival. Surg Endosc 2019 Feb;33(2):460-470.
- Moloo H, Haggar F, Martel G, Grimshaw J, Coyle D, Graham ID, et al. The adoption of laparoscopic colorectal surgery: a national survey of general surgeons. Can J Surg. 2009 Dec;52(6):455-62.
- Chan BP, Gomes T, Musselman RP, Auer RC, Moloo H, Mamdani M, et al. Trends in colon cancer surgery in Ontario: 2002-2009. Colorectal Dis. 2012 Oct;14(10):e708-12.
- Simunovic M, Baxter NN, Sutradhar R, Liu N, Cadeddu M, Urbach D. Uptake and patient outcomes of laparoscopic colon and rectal cancer surgery in a publicly funded system and following financial incentives. Ann Surg Oncol. 2013 Nov;20(12):3740-6.
- Doumouras AG, Saleh F, Eskicioglu C, Amin N, Cadeddu M, Hong D. Neighborhood Variation in the Utilization of Laparoscopy for the Treatment of Colon Cancer. Dis Colon Rectum 2016 Aug;59(8):781-788.
- Aslani N, Lobo-Prabhu K, Heidary B, et al. Outcomes of laparoscopic colon cancer surgery in a population-based cohort in British Columbia: Are they as good as the clinical trials? Am J Surg. 2012;204:411–5. [PubMed] [Google Scholar]
- Birch DW, Sample C, Gupta R. The impact of a comprehensive course in advanced minimal access surgery on surgeon practice. Can J Surg. 2007;50:9–12. [PMC free article] [PubMed] [Google Scholar]
- Urbach DR. Closing in on surgical practice variations. Ann Surg. 2014;259:628–9. [PubMed] [Google Scholar]
- Birch DW, Bonjer HJ, Crossley C, et al. Canadian consensus conference on the development of training and practice standards in advanced minimally invasive surgery: Edmonton, Alta., Jun. 1, 2007. Can J Surg. 2009;52:321–7. [PMC free article] [PubMed] [Google Scholar]
- Birch DW, Misra M, Farrokhyar F. The feasibility of introducing advanced minimally invasive surgery into surgical practice. Can J Surg. 2007;50:256–60. [PMC free article] [PubMed] [Google Scholar]
- Coleman MG, Hanna GB, Kennedy R, National Training Programme Lapco. The National Training Programme for Laparoscopic Colorectal Surgery in England: a new training paradigm. Colorectal Dis 2011 Jun;13(6):614-616.
- De’Ath HD, Devoto L, Mehta C, Bromilow J, Qureshi T. Mentored Trainees have Similar Short-Term Outcomes to a Consultant Trainer Following Laparoscopic Colorectal Resection. World J Surg 2017 Jul;41(7):1896-1902.
- Mackenzie H, Cuming T, Miskovic D, Wyles SM, Langsford L, Anderson J, et al. Design, delivery, and validation of a trainer curriculum for the national laparoscopic colorectal training program in England. Ann Surg 2015 Jan;261(1):149-156.
- Mackenzie H, Miskovic D, Ni M, Parvaiz A, Acheson AG, Jenkins JT, et al. Clinical and educational proficiency gain of supervised laparoscopic colorectal surgical trainees. Surg Endosc 2013 Aug;27(8):2704-2711.
- Mackenzie H, Miskovic D, Ni M, Tan WS, Keller DS, Tang CL, et al. Risk prediction score in laparoscopic colorectal surgery training: experience from the English National Training Program. Ann Surg 2015 Feb;261(2):338-344.
- Mackenzie H, Ni M, Miskovic D, Motson RW, Gudgeon M, Khan Z, et al. Clinical validity of consultant technical skills assessment in the English National Training Programme for Laparoscopic Colorectal Surgery. Br J Surg 2015 Jul;102(8):991-997.
- Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum 2012 Dec;55(12):1300-1310.
- Miskovic D, Wyles SM, Carter F, Coleman MG, Hanna GB. Development, validation and implementation of a monitoring tool for training in laparoscopic colorectal surgery in the English National Training Program. Surg Endosc 2011 Apr;25(4):1136-1142.
- Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB. Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg 2010 Dec;252(6):943-951.
This program was founded with an educational grant from Medtronic.