Developing and assessing a cadaveric training model for transanal total mesorectal excision: initial experience in the UK and USA
Developing and assessing a cadaveric training model for transanal total mesorectal excision: initial experience in the UK and USA
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DOI：
10.1111/codi.13525
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发表时间：
2017-05-01
影响因子：
3.4
通讯作者：
Sylla, P.
中科院分区：
文献类型：
--
作者：
Penna, M.;Whiteford, M.;Sylla, P.
目的随着越来越多的外科医生接受培训，经肛门全直肠系膜切除术(TaTME)已成为直肠癌外科治疗中最有前途的技术进步之一。我们描述了我们在两个国家举办的TTME人体身体课程的经验。方法2015年在英国牛津举办的四个新鲜人体身体讲习班，以及2013+/-2014年在美国芝加哥举办的两个新鲜人体身体讲习班，总共培训了52名外科医生。记录每个代表的手术操作参数。结果47例患者在身体模型上进行了taTME手术。参与的外科医生以前有过腹腔镜TME手术和经肛门入路的经验，但接触taTME的机会有限。在93%的英国和60%的美国病例中，钱包始终处于闭塞状态。两国关键手术步骤的手术时间相似，从开始环切到进入腹膜的平均时间为79.5分钟(范围25-155)。96%的外科医生经肛门解剖达到S2或以上。81%的TME标本质量完全或接近完成，在第一次和第二次手术之间注意到了改善。81%的受访外科医生目前正在当地医院进行TTME手术。结论新鲜冷冻身体为复杂的骨盆外科提供了良好的教学模式。包括阅读材料、干实验室钱包练习和课程后指导在内的结构化培训课程将为外科医生提供更完整的培训方案和持续的支持，最终确保taTME在临床环境中的安全引入。
Aim Transanal total mesorectal excision (taTME) has become one of the most promising technical advancements in the surgical treatment of rectal cancer, with rising numbers of surgeons seeking training. We describe our experience with human cadaveric courses for taTME delivered in two countries.Method Four fresh human cadaveric workshops conducted in Oxford, UK, in 2015 and two in Chicago, USA, in 2013 +/- 2014, trained a total of 52 surgeons. Parameters of operative performance for each delegate were recorded. Previous surgical experience and uptake of taTME in the surgeons' clinical setting were surveyed.Results Forty-seven taTME cases were performed on cadaveric models. Participating surgeons had previous experience in laparoscopic TME surgery and transanal approaches but limited taTME exposure. The pursestring remained occluded throughout in 93% of UK and 60% of US cases. Operative timings for key procedural steps were similar between the two countries with a mean time from start of circumferential dissection to peritoneal entry of 79.5 min (range 25-155). 96% of surgeons dissected transanally to a level S2 or above. The TME specimen quality was complete or near complete in 81%, with improvements noted between the first and second procedure performed. 81% of surgeons surveyed are currently performing taTME in their local hospitals.Conclusion Fresh-frozen cadavers provide excellent teaching models for complex pelvic surgery. A structured training curriculum including reading material, dry-lab purse-string practice and postcourse mentorship will provide surgeons with a more complete training package and ongoing support, to ultimately ensure the safe introduction of taTME in the clinical setting.