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TRAINING CURRICULUM FOR ROBOTIC colon and RECTAL SURGERY

Laparoscopy has become the gold standard for the treatment of colorectal cancer in the Western World. It is associated with better short term outcomes, like less postoperative pain, less blood loss, reduced analgesia requirement and shorter hospital stay.

Whilst Laparoscopic colonic surgery is relatively easy to perform with no impact on oncological outcomes, Laparoscopic rectal cancer surgery is associated with higher morbidity and higher rates of conversion to open procedure.

Pelvic surgery for rectal cancer presents the technical challenges of bony confines, access and exposure issues, that makes this surgery technically very challenging.

With the robotic system, some of these technical issues of exposure, access and wrist manipulation can be overcome with appropriate training.

The EARCS training programme is designed to improve patient outcomes for European colorectal cancer patients by improving the entire surgeon learning pathway for minimally invasive surgery, including technology, training, mentor relationships and data evaluation. Training will be given by the EARCS faculty.

Aim

The aim of the programme is to train surgeons to perform robotic rectal resection surgery so they can become independent in delivery of such service.

Selection criteria for the Candidates

Surgeons who wish to enter into the training programme have to apply to the EACRS coordination office for their application review and approval. The following selection criteria apply:

  • Consultant surgeon with volume of colorectal practice
  • Support from hospital executives
  • Access to robotic system on regular basis
  • Experience in laparoscopic surgery desirable but not essential

Steps of Training

Following the approval and entry into the programme, delegates will be sent information outlining the timeline and venues for their training. Delegates are expected to pass an assessment to progress to next step of training. The programme includes the following steps:

  • Case Observations at Faculty Member Institutions
    This step includes attending lectures, which cover thorough knowledge of pelvic anatomy and the theory behind Total Mesorectal Excision (TME) surgery. This two-day course will involve lecture-based teaching as well as live case observation.
  • System and Dissection Training Course (two consecutive days)

    • Day One: Console/System Training Course
      This course will be delivered at a designated training centre to provide insight and competence with the system and console for delegates. There is a process of assessment at the end of the training. This is designed to introduce delegates to the concept of applying the robotic system to perform surgical procedures. The porcine training model is used to achieve this.
    • Day Two: Procedure Specific Cadaveric Course
      This course is aimed at delivering hands on training for delegates using cadaveric material at a designated training centre. The course will be delivered under the direct supervision of EARCS faculty.
  • Hands-On Training at the Faculty Members Hospital and/or Trainees Own Hospital
    The clinical hands-on training consists of two proposed models. Firstly, delegates are encouraged to go to the institution of an EARCS faculty member (of their choice) to participate in hands-on training. This is followed by EARCS proctor visits to the delegate's hospital to supervise training in that setting. Delegates are expected to do at least five left sided resections before doing a further five rectal resections under the direct supervision of the proctor.

Careful case selection is advised, particularly at the start of the training programme, to help achieve competence before embarking on more challenging cases. Although choosing cases with a diagnosis of cancer is encouraged, benign cases can be used for training purpose where appropriate, following discussions between the proctor and the delegate.

Final Assessments for Competence

All of the training will be assessed and scored using Global Assessment Score (GAS) forms, completed and submitted in a secure on-line platform by both the delegate and proctor. At the end of the total number of cases performed, delegates are expected to submit two videos of self performed robotic LAR for 'blind' assessment in order to graduate from the programme and receive certification.

Timeline for the Training Programme

The timeline for completion of the programme is expected to be approximately 16 weeks. It is expected that clear demonstration of competence will be achieved before moving onto the next step of training.

Funding for the Training programme

It is expected that funding will be responsibility of the trainees who wish to undertake this programme.