1. Introduction
La cirugía laparoscópica colorrectal ha evolucionado en los últimos años desde un enfoque del tratamiento de la patología benigna y aplicado por reducido número de cirujanos a estar ampliamente distribuido a nivel mundial e incluyendo patología maligna de colon y de recto. Aun así, todavía queda trabajo para una mayor implementación equitativa entre los distintos países mundialmente además de estandarizar entre diferentes abordajes como el laparoscópico puro, asistido, mano-asistido, robótico, single-port \cite{Blackmore_2014} \cite{Davis_2018} . En cualquiera de los casos, el abordaje mínimamente invasivo colorrectal parece demostrar ventajas, o al menos no peores resultados que el convencional en términos de calidad de vida, menor dolor y complicaiones, costes, seguridad, márgenes de resección, etc. \cite{van_der_Pas_2013} \cite{Mar_2018} Y aunque en el caso específico del recto, puede haber mayores reticencias \cite{Toda_2013} \cite{Fleshman_2016}, es universalmente aceptado que la cirugía laparoscópica colorrectal solo pesentará ventajas en pacientes bien seleccionados y por cirujanos que tienen apropiada formación y experiencia\cite{van_der_Pas_2013} \cite{Mar_2018}
No hay duda tampoco en que la cirugía laparoscópica colorrectal es de tipo avanzadoy que conlleva una importante curva de aprendizaje y seguir programas de entrenamiento, capacitación, fellowship and continous mentorship and continuous number of cases per year y \cite{Parker_2017}. Y es por ello que una gran variedad de agrupaciones médicas se ocupen de establecer criterios de entramiento y certificación de dichas habilidades a través de cursos, modelos de simulación, programas de entrenamiento etc. \cite{Davis_2018}\cite{Bashankaev_2010} \cite{Szasz_2016}(¿¿¿hacer una tabla???) FLS, LCAT,SAGES,etc para que esas habilidades se transfieran de manera efctiva al quirófano y pacientes.
- Hablar de lo que hay en al carpeta de formación de doctorado en otros modelos de laparoscopia y de digestivo o colon en concreto, LCAT, CSLC, SAGES, ABS etc
De una u otra forma, la combinar modelos de simulación con cadáver y animal es una práctica apropiada ara el desarrollo y evaluación de habilidades quirúrgicas técnicas y no técnicas en cirugía colorectal \cite{Marecik_2015} \cite{Celentano_2015} \cite{Gaitanidis_2018}. Y es por ello que se necesita continuar en el desarrollo y validación de modelos de entreamiento en laparoscopia abdominal avanzada \cite{Beyer_Berjot_2014}.
We present our structured training program and its validation after ten editions of the Advanced Laparoscopic Colorectal organised by our centre and endorsed by the European Association of Endoscopic Surgeons (EAES).
Methods:
\cite{Enciso_2016} Todas las actividades de formacion fueron aprobadas por el Comité de Ética y de Bienestar Animal de nuestro centro that complies with the European regulations on protection aof animals used for experimentation and other scientific purposes. The present study was performed with this approval and under continuous supervision by a veterinary surgeon responsible for animal well-being. On days 2–5, the residents perform surgical procedures on live pigs under the direction of attending laparoscopic surgeons. The pigs are anesthetized and attended by veterinarians and animal surgery technicians throughout the day. Personnel Establishing our course was a major undertaking. It requires the dedicated participation of a number of faculty members and of additional staff members, such as coordinators,
scrub technicians, research fellows, and nurses. Our four core faculty members (who have advanced skills
in laparoscopic surgery and are from various surgical disciplines) rotate through the course on a regular basis, with
the administrative guidance of a course director per session; other faculty members help with different segments
of the course as needed. This setup ensures that faculty members will not burn out, that their involvement in
teaching the course will not significantly affect their practice and other academic obligations.
Proficiency criteria
- \cite{Day_2016} Tiempo límite: Decir que elegimos 7minutos porque es el dobre de tiempo medio establedicod para un experto en nuetr simulador (ver referencias de la tesis o de Silvia: SIMULAP, MODELO NEFRECTOMÍA Y \cite{Enciso_2016} Validación de un modelo de formación intensiva en cirugía digestiva laparoscópica) o comparar arbitrariamente con los 8 minutos del 8 MST rapid assessment "Their real-time and video-recorded performance was scored by two blinded evaluators and compared with their faculty-ratedThe 8MST is a rapid, feasible, inexpensive, reliable, and valid test for assessment of surgical trainee technical abilities"
- This course is based on the practice of sigmoidectomy (SG) and ileocecal resection (IR) in the porcine model. In addition, there is an emphasis on the objective assessment of laparoscopic intracorporeal suturing (LIS) skills, required for the resolution of complications, or the improvement of the anastomosis manoeuvres. It consists of 2.5 days long with 2/3 parts of practice. Remaining time is spent on theoretical-audiovisual contents. During the first morning, theoretical concepts of ergonomics in laparoscopy are taught to subsequently practice LIS in box-trainer on inorganic and organic tissues. At this point both techniques of SG and IR in porcine model will be performed by each attendant until the end of the course (Figure 1); participants are assisted by the expert faculty at any time. In addition, both the first day in box-trainer (P1), as the last day in animal model (P2), attendants´ LIS skills are objectively assessed through a level test by performing a simple stitch (Figure 2). Also, at the end of the training course, the 68 trainees subjectively ranked various educational and organizational topics of the training program by means of a questionnaire.
We organized a 2.5 days theoretical and practical courses. A total number of 146 participants completed
these courses (Fig. 1). A previous Elearning web platform is used to prepare the hands-on box trainer
tasks. The learning objectives include the acquisition of operative techniques and appreciation of
surgical strategies to allow the candidate to progress porcine sigmoidectomy and ileocecal resection.
Objective Assessment of laparoscopic intracorporeal suturing (LIS) is emphasized by means of initial
level test and acquired learning curve (time, errors). Also, at the end of the course, trainees subjectively
rank various educational and organizational topics of the training program by means of a questionnaire.