F Aigner1, M Biebl2, A Fürst3, T Jöns4, J Pratschke2, W Kneist5. 1. Chirurgische Klinik, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland. felix.aigner@charite.de. 2. Chirurgische Klinik, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland. 3. Klinik für Allgemein-, Viszeral-, Thoraxchirurgie, Adipositasmedizin, Caritas-Krankenhaus St. Josef, Landshuterstr. 65, 93053, Regensburg, Deutschland. 4. Institut für Integrative Neuroanatomie, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Philippstraße 12, 10117, Berlin, Deutschland. 5. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Abstract
BACKGROUND: In recent years the video endoscopy-assisted transanal approach to total mesorectal excision (TME) combined with the conventional laparoscopic technique was developed as an alternative indication for treatment of low rectal cancer (TaTME). OBJECTIVE: The concept and results of the first German TaTME hands-on cadaver course with subsequent live surgery are presented. MATERIAL AND METHODS: The 2‑day training course was structured into an anatomical and a clinical surgery part. The participants could learn from basics to live surgery and shared their experiences during presentations about currently available data, rationale and technique of TaTME with special emphasis on technical failures and pitfalls. The supervised simulator training and TaTME exercises at three cadaver work stations were proctored by experienced surgeons. On day 2 the participants observed two cases of TaTME at the moderated live surgery session. RESULTS: The step-up learning curve for the transanal approach could be clearly observed in each team from warm-up to hands-on training sessions. In the practical session the participants could train the milestones of the transanal approach on cadavers, including the pitfalls. Finally, the participants observed live surgery on two patients with low rectal tumors on day 2 of the course. CONCLUSION: A step-up training course on cadavers is indispensable regarding implementation of techniques, such as TaTME into clinical practice. Coordinated clinical guest demonstrations provide translation of theoretical basic principles and practical skills from the cadaver course to real patient treatment. Participants should be encouraged to report their cases to registered trials or registries.
BACKGROUND: In recent years the video endoscopy-assisted transanal approach to total mesorectal excision (TME) combined with the conventional laparoscopic technique was developed as an alternative indication for treatment of low rectal cancer (TaTME). OBJECTIVE: The concept and results of the first German TaTME hands-on cadaver course with subsequent live surgery are presented. MATERIAL AND METHODS: The 2‑day training course was structured into an anatomical and a clinical surgery part. The participants could learn from basics to live surgery and shared their experiences during presentations about currently available data, rationale and technique of TaTME with special emphasis on technical failures and pitfalls. The supervised simulator training and TaTME exercises at three cadaver work stations were proctored by experienced surgeons. On day 2 the participants observed two cases of TaTME at the moderated live surgery session. RESULTS: The step-up learning curve for the transanal approach could be clearly observed in each team from warm-up to hands-on training sessions. In the practical session the participants could train the milestones of the transanal approach on cadavers, including the pitfalls. Finally, the participants observed live surgery on two patients with low rectal tumors on day 2 of the course. CONCLUSION: A step-up training course on cadavers is indispensable regarding implementation of techniques, such as TaTME into clinical practice. Coordinated clinical guest demonstrations provide translation of theoretical basic principles and practical skills from the cadaver course to real patient treatment. Participants should be encouraged to report their cases to registered trials or registries.
Entities:
Keywords:
Anatomy; Guest relation; Simulator training; Total mesorectal excision; Transanal
Authors: Werner Kneist; Andreas D Rink; Daniel W Kauff; Moritz A Konerding; Hauke Lang Journal: Int J Colorectal Dis Date: 2014-10-15 Impact factor: 2.571
Authors: F Aigner; R Hörmann; H Fritsch; J Pratschke; A D'Hoore; E Brenner; N Williams; M Biebl Journal: Colorectal Dis Date: 2015-02 Impact factor: 3.788
Authors: Charlotte L Deijen; Simone Velthuis; Alice Tsai; Stella Mavroveli; Elly S M de Lange-de Klerk; Colin Sietses; Jurriaan B Tuynman; Antonio M Lacy; George B Hanna; H Jaap Bonjer Journal: Surg Endosc Date: 2015-11-04 Impact factor: 4.584