Developments in Laparoscopic Colorectal

Surgery

Technology appraisal TA105

• 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

Recommends laparoscopic surgery as an alternative to open surgery for people with colorectal cancer if:

CSCG3rd Bowel Cancer ReportApr 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

127%

211%3

40%

422%

36/45 80% response rate

no plans to start

want to startoff and running

ready to teach

4

3

12

24

31

12

Should be part of MDT discussion?

• Yes 26/37 70%• No 5/37

14%• No answer 6/37

16%

What % patients realistically are suitable?

0

2

4

6

8

10

12

14

16

18

<10% 10-50% 50-75% >75%

Barriers to offering more lap surgery to your patients?

02468

10121416

Tim

e

Equip

men

t

Trai

ning/

conf

iden

ce

Patien

t co-

mor

bidity

Other

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

AppendixRight Hemi

Left side Resection

Animal Lab

BSS Course

Core Skills Laparoscopy

AppendixRight Hemi

Left Side Resection

Animal Lab

CT1/2

ST3/4

ST 5/6

ST 7/8

Colorectal

Trainee

Coordination

Administration

ContactKate Creighton

Griffiths02920 71682128Creighton-

griffithsk@cardiff.ac.uk

Teaching Faculty

Incl. audit

RITA committee