Annals of Coloproctology

Review

Minimally invasive surgery

Robotic colorectal surgery training: Portsmouth perspective: Guglielmo Niccolò Piozzi, Sentilnathan Subramaniam, Diana Ronconi Di Giuseppe, Rauand Duhoky, Jim S. Khan; Ann Coloproctol. 2024;40(4):350-362. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00444.0063

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This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

Citations

Citations to this article as recorded by

Robotic-assisted colorectal surgery in colorectal cancer management: a narrative review of clinical efficacy and multidisciplinary integration
Engeng Chen, Li Chen, Wei Zhang
Frontiers in Oncology.2025;[Epub] CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef

Original Articles

Colonoscopy

Analysis of adenoma detection rate of colonoscopy among trainees: Young Min Song, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Bun Kim, Min Chul Kim, Myeong Jae Jin, Dae Kyung Sohn; Ann Coloproctol. 2024;40(6):548-554. Published online August 28, 2024; DOI: https://doi.org/10.3393/ac.2023.00199.0028

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Abstract PDF Supplementary Material: Purpose
To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training.
Methods
ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined.
Results
The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606).
Conclusion
In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Benign GI diease

Resident Learning Curve for Laparoscopic Appendectomy According to Seniority: Chang Woo Kim, Sook Young Jeon, Bomina Paik, Jun Woo Bong, Sang Hyun Kim, Suk-Hwan Lee; Ann Coloproctol. 2020;36(3):163-171. Published online February 14, 2020; DOI: https://doi.org/10.3393/ac.2019.07.20

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10 Web of Science
9 Citations

Abstract PDF

Purpose
To delineate the learning curve (LC) for laparoscopic appendectomy (LA) performed by residents according to seniority in training.
Methods
Between October 2015 and November 2016, 150 patients underwent LA by three residents (in their first, second, and third year of training) under supervision. The patients were non-randomly assigned to each resident. The data were reviewed and analyzed retrospectively from prospectively collected database. The perioperative outcomes were compared between the three residents including operation time, complication, conversion, and so on. The LCs were evaluated by the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion.
Results
Baseline characteristics and perioperative outcomes were similar except for age and location of the appendix among the three groups. Operation time was not different among the three residents (43.9, 45.3, and 48.4 min for A, B, and C, respectively). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM for operation time showed that the peak points occurred at the 24th, 18th, and 31st cases for resident A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after the 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure.
Conclusion
The LC for LA by residents was 11-35 cases according to multidimensional statistical analyses. The accumulation of surgical experience of residents might affect the LC, especially for surgical completion rather than for operation time.

Citations

Citations to this article as recorded by

Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon
Theophilus TK. Anyomih, Thomas Jennings, Alok Mehta, J Robert O'Neill, Ioanna Panagiotopoulou, Stavros Gourgiotis, Elizabeth Tweedle, John Bennett, R Justin Davies, Constantinos Simillis
The American Journal of Surgery.2023; 225(1): 168. CrossRef
Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study
Nathalie Young, Rebecka Ahl Hulme, Maximilian Peter Forssten, Lewis Jay Kaplan, Thomas Noel Walsh, Yang Cao, Shahin Mohseni, Gary Alan Bass, Alan Biloslavo, Hayato Kurihara, Isidro Martinez-Casas, Jorge Pereira, Arvid Pourlotfi, Éanna J. Ryan, Matti Tolon
European Journal of Trauma and Emergency Surgery.2023; 49(1): 33. CrossRef
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chiri
World Journal of Emergency Surgery.2023;[Epub] CrossRef
How does the number of training years in pediatric surgery affect appendectomy outcomes?
Carlos Delgado-Miguel, Miriam Miguel-Ferrero, María San Basilio, Carla Ramírez, Juan Camps, Francisco Hernández Oliveros
Pediatric Surgery International.2023;[Epub] CrossRef
Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature
Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon
Annals of Coloproctology.2022; 38(2): 160. CrossRef
Laparoscopic appendicectomy without the use of disposable materials - a low-cost alternative - 1,552 cases operated in 20 years
CARLOS EDUARDO DOMENE, PAULA VOLPE, ANDRÉ VALENTE SANTANA
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery
Hyung Ook Kim
Annals of Coloproctology.2022; 38(3): 276. CrossRef
Factors Influencing the Difficulty and Need for External Help during Laparoscopic Appendectomy: Analysis of 485 Procedures from the Resident-1 Multicentre Trial
Stefano Cioffi, Andrea Spota, Michele Altomare, Stefano Granieri, Roberto Bini, Francesco Virdis, Federica Renzi, Elisa Reitano, Osvaldo Chiara, Stefania Cimbanassi
Journal of Personalized Medicine.2022; 12(11): 1904. CrossRef
Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea
Chang Woo Kim, Suk-Hwan Lee
Annals of Surgical Treatment and Research.2021; 101(4): 240. CrossRef

Knowledge of and Practice Patterns for Hereditary Colorectal Cancer Syndromes in Korean Surgical Residents: Jangho Park, Soo Young Lee, Duck-Woo Kim, Sung-Bum Kang, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2013;29(5):186-191. Published online October 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.5.186

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Abstract PDF

Purpose

Obtaining a detailed family history through detailed pedigree is essential in recognizing hereditary colorectal cancer (CRC) syndromes. This study was performed to assess the current knowledge and practice patterns of surgery residents regarding familial risk of CRC.

Methods

A questionnaire survey was performed to evaluate the knowledge and the level of recognition for analyses of family histories and hereditary CRC syndromes in 62 residents of the Department of Surgery, Seoul National University Hospital. The questionnaire consisted of 22 questions regarding practice patterns for, knowledge of, and resident education about hereditary CRC syndromes.

Results

Two-thirds of the residents answered that family history should be investigated at the first interview, but only 37% of them actually obtained pedigree detailed family history at the very beginning in actual clinical practice. Three-quarters of the residents answered that the quality of family history they obtained was poor. Most of them could diagnose hereditary nonpolyposis colorectal cancer and recommend an appropriate colonoscopy surveillance schedule; however, only 19% knew that cancer surveillance guidelines differed according to the family history. Most of our residents lacked knowledge of cancer genetics, such as causative genes, and diagnostic methods, including microsatellite instability test, and indicated a desire and need for more education regarding hereditary cancer and genetic testing during residency.

Conclusion

This study demonstrated that surgical residents' knowledge of hereditary cancer was not sufficient and that the quality of the family histories obtained in current practice has to be improved. More information regarding hereditary cancer should be considered in education programs for surgery residents.

Citations

Citations to this article as recorded by

Transition of care in pediatric hereditary polyposis: the why, how and to whom
Thomas M. Attard, Ajay Bansal, Caitlin E. Lawson, Nicole Stoecklein, Michele H. Maddux
Expert Review of Gastroenterology & Hepatology.2025; : 1. CrossRef
Efficacy, functional outcome and post‑operative complications of total abdominal colectomy with ileorectal anastomosis vs. segmental colectomy in hereditary non‑polyposis colorectal cancer
Jie Sun, Mingjie Dong, Xiaoping Xiao
Experimental and Therapeutic Medicine.2018;[Epub] CrossRef
Clinicopathological Features and Type of Surgery for Lynch Syndrome: Changes during the Past Two Decades
Il Tae Son, Duck-Woo Kim, Seung-Yong Jeong, Young-Kyoung Shin, Myong Hoon Ihn, Heung-Kwon Oh, Sung-Bum Kang, Kyu Joo Park, Jae Hwan Oh, Ja-Lok Ku, Jae-Gahb Park
Cancer Research and Treatment.2016; 48(2): 605. CrossRef

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