Nader Francis, Professor1, Fiona Carter, Dr2, Marta Penna, Ms3, George Hanna, Professor3, Roel Hompes, Mr4. 1Yeovil District Hospital, 2SWSTNcic, 3Imperial College London, 4Oxford University Hospitals
Introduction: Transanal total mesorectal excision (TaTME) has attracted substantial interest amongst colorectal surgeons throughout the world. Technical challenges of the technique however have been acknowledged by early adopters and this may underpin the early reports of visceral injuries which occurred during the perineal phase. Evidence from previous surgical training programs suggest that a structured proctorship programme can shorten the learning curve, operative time and most importantly reduce major complications. The aim of this study was to report on the first national pilot training initiative which was developed in the UK to ensure safe introduction of this technique.
Methods: A pilot training programme for the UK has been established in partnership with the healthcare industry, and supported by the Association of Coloproctology of Great Britain and Ireland. The programme consists of three phases: (i) Development of a consensus process on the optimum training curriculum of TATME from all relevant stakeholders, including experts, early adopters, and potential learners, to guide the training of this technique (ii) Piloting of this training curriculum and (iii) Assessment and quality assurance mechanisms to monitor training and measure outcomes.
Results: A cohesive multi-modal training curriculum has been developed providing clear guidance on case selection, supporting multi-disciplinary and multimodal training including online modules, dry-lab, purse-string simulators, cadaveric training and formal clinical proctoring programme. The UK pilot programme opened for applications in May 2017 and, after a rigorous selection process, the initiative was launched in September 2017 with 10 trainers mentoring 10 consultant colorectal surgeons from five centres. The selection of learners was based on suitable case volume and prior experience in laparoscopic rectal surgery. Objective assessment tools were applied to an unedited video of a laparoscopic rectal surgery case for each applicant. For the selected centres, access to the iLapp TaTME app was provided to access educational content including operative video footage, prior to attending a bespoke cadaveric workshop. Each learner will then benefit from a structured, centrally organised and funded proctorship programme at their own institutions. A global assessment score form has been specifically designed to monitor training and a formal accreditation process will be used to sign off each learner using competency assessment tool. Data on the cadaveric workshop and initial outcomes of the clinical mentorship will be presented at the conference.
A competency-based pilot training programme for transanal total mesorectal excision has been launched in the UK to support safe introduction of this technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87727
Program Number: P341
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster