Nader Francis1,2, Marta Penna3,4, Hugh Mackenzie4, Fiona Carter5, Roel Hompes3. 1. Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, Somerset, BA21 2RH, UK. nader.francis@ydh.nhs.uk. 2. Faculty of Science, University of Bath Wessex, House 3.22, Bath, BA2 7AY, UK. nader.francis@ydh.nhs.uk. 3. Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK. 4. Department of Surgery and Cancer, Imperial College London, London, UK. 5. South West Surgical Training Network, Yeovil, Somerset, UK.
Abstract
BACKGROUND: The interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME. METHODS: A consensus process to agree on the framework of the TaTME training curriculum was conducted, seeking views of 207 surgeons across 18 different countries, including 52 international experts in the field of TaTME. The process consisted of surveying potential learners of this technique, an international experts workshop and a final expert's consensus to draw an agreement on essential elements of the curriculum. RESULTS: Appropriate case selection was strongly recommended, and TaTME should be offered to patients with mid and low rectal cancers, but not proximal rectal cancers. Pre-requisites to learn TaTME should include completion of training and accreditation in laparoscopic colorectal surgery, with prior experience in transanal surgery. Ideally, two surgeons should undergo training together in centres with high volume for rectal cancer surgery. Mentorship and multidisciplinary training were the two most important aspects of the curriculum, which should also include online modules and simulated training for purse-string suturing. Mentors should have performed at least 20 TaTME cases and be experienced in laparoscopic training. Reviewing the specimens' quality, clinical outcome data and entering data into a registry were recommended. Assessment should be an integral part of the curriculum using Global Assessment Scales, as formative assessment to promote learning and competency assessment tool as summative assessment. CONCLUSIONS: A detailed framework for a structured TaTME training curriculum has been proposed. It encompasses various training modalities and assessment, as well as having the potential to provide quality control and future research initiatives for this novel technique.
BACKGROUND: The interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME. METHODS: A consensus process to agree on the framework of the TaTME training curriculum was conducted, seeking views of 207 surgeons across 18 different countries, including 52 international experts in the field of TaTME. The process consisted of surveying potential learners of this technique, an international experts workshop and a final expert's consensus to draw an agreement on essential elements of the curriculum. RESULTS: Appropriate case selection was strongly recommended, and TaTME should be offered to patients with mid and low rectal cancers, but not proximal rectal cancers. Pre-requisites to learn TaTME should include completion of training and accreditation in laparoscopic colorectal surgery, with prior experience in transanal surgery. Ideally, two surgeons should undergo training together in centres with high volume for rectal cancer surgery. Mentorship and multidisciplinary training were the two most important aspects of the curriculum, which should also include online modules and simulated training for purse-string suturing. Mentors should have performed at least 20 TaTME cases and be experienced in laparoscopic training. Reviewing the specimens' quality, clinical outcome data and entering data into a registry were recommended. Assessment should be an integral part of the curriculum using Global Assessment Scales, as formative assessment to promote learning and competency assessment tool as summative assessment. CONCLUSIONS: A detailed framework for a structured TaTME training curriculum has been proposed. It encompasses various training modalities and assessment, as well as having the potential to provide quality control and future research initiatives for this novel technique.
Authors: Hugh Mackenzie; Tamzin Cuming; Danilo Miskovic; Susannah M Wyles; Laura Langsford; John Anderson; Siwan Thomas-Gibson; Roland Valori; George B Hanna; Mark G Coleman; Nader Francis Journal: Ann Surg Date: 2015-01 Impact factor: 12.969
Authors: Marta Penna; Roel Hompes; Steve Arnold; Greg Wynn; Ralph Austin; Janindra Warusavitarne; Brendan Moran; George B Hanna; Neil J Mortensen; Paris P Tekkis Journal: Ann Surg Date: 2017-07 Impact factor: 12.969
Authors: Hugh Mackenzie; Danilo Miskovic; Melody Ni; Amjad Parvaiz; Austin G Acheson; John T Jenkins; John Griffith; Mark G Coleman; George B Hanna Journal: Surg Endosc Date: 2013-02-08 Impact factor: 4.584
Authors: F Borja de Lacy; Deborah Susan Keller; Beatriz Martin-Perez; Sameh Hany Emile; Manish Chand; Antonino Spinelli; Antonio M Lacy Journal: Surg Endosc Date: 2019-01-23 Impact factor: 4.584
Authors: T W A Koedam; M Veltcamp Helbach; P M van de Ven; Ph M Kruyt; N T van Heek; H J Bonjer; J B Tuynman; C Sietses Journal: Tech Coloproctol Date: 2018-03-22 Impact factor: 3.781