Developments in Laparoscopic Colorectal Surgery

							   Developments in
Laparoscopic Colorectal
       Surgery
Technology appraisal
TA105
       Recommends laparoscopic surgery
       as an alternative to open surgery for
       people with colorectal cancer if:
      • Both laparoscopic and open
        surgery are suitable for the person
        and their condition
      • Their surgeon has been trained in
        laparoscopic surgery for colorectal
        cancer and performs the operation
        often enough to keep his or her
        skills up to date
CSCG
3rd Bowel Cancer Report
Apr 2005 – March 2007
History of programme


       • DoH and Cancer Action Team
         provide money for England
       • Sept 2007
       • 3 preceptors in Wales
       • WAG agreed funding on
         scheme administered from
         WIMAT
       • 29 Aug 08 appointed Lead
         Wales
       • 23 Sept 08 New Lead England
Multiple reservations



        •   Too prescriptive
        •   Credentialling / Accrediation
        •   5 or 10 years too late
        •   Resentment about equipment
        •   Multiple new appointments
        •   Existing training schemes
Aims of the programme



       • Ensure that all patients
         suitable for laparoscopic
         colorectal cancer resection
         have access to the choice
       • Ensure a legacy of
         laparoscopic colorectal
         training in Wales
Questionnaire 45 colorectal
surgeons

  Abdullah Appleton Arun Beynon Bhowmick
  Billings Carr Chamery Davies(1) Davies(2)
  Delicata Edwards Foster Ghopal Haray
  Hargest Harries Jackson Jamison Joseph
  Khot Lala Marsh Masoud Maw McKain
  Milewski Morgan Phillips Pritchard Radcliffe
  Rees Rowley Sekeran Shami Shanahan
  Sheridan Stephenson Swankar Torkington
  Umughele Whiteley Williams Woodward
  Young
36/45 80% response rate




                                  no plans to start
     ready to teach
                       4     1
                      22%   27%

                             2
                       3    11%   want to start
   off and running    40%
    2 3
                  1




1                 1
    3     2
              4       4
          2
Should be part of MDT
discussion?


       • Yes            26/37   70%
       • No             5/37    14%
       • No answer      6/37    16%
What % patients realistically are
suitable?



  18
  16
  14
  12
  10
   8
   6
   4
   2
   0
         <10%        10-50%         50-75%   >75%
Barriers to offering more lap surgery to your
patients?



 16
 14
 12
 10
  8
  6
  4
  2
  0




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Current Consultants

                             Teams




        Future Consultants
Current Consultants



       • Bespoke training/support
       • Non threatening
       • Not accreditation

       • Courses
       • Coordinating preceptorship
       • Own hospital or host
Team training



       • Anaesthetist
       • Scrub nurses
       • Access to integrated theatre
         system
       • Oesophageal doppler
       • Support group
Future consultants



       • Self sufficient in Wales for
         training
       • Expect laparoscopic colorectal
         training by CCST
       • “Technique not a speciality”
BSS Course



              Core skills
             Laparoscopy
BSS Course



              Core skills
             Laparoscopy

                                          Animal Lab
                             Appendix
                            Right Hemi


                                         Left side
                                         Resection
BSS Course   CT1/2



             Core Skills
                           ST3/4
             Laparoscopy

                                         Animal Lab
                            Appendix
                ST 5/6
Colorectal                 Right Hemi

Trainee
                                        Left Side
                             ST 7/8     Resection
Coordination
                                     Teaching
                                      Faculty
                                     Incl. audit
    Administration




    Contact
    Kate Creighton Griffiths
    02920 71682128                RITA committee
    Creighton-
       griffithsk@cardiff.ac.uk