Laparoscopic Colorectal Surgical Training: A Curricular Approach

Large, prospective, multi-centre randomized trials have confirmed the role of minimally invasive colorectal procedures in the armamentarium of the surgical specialist. However, the learning curve for this procedure has been stated to be of the order of 50 to 400 procedures for a variety of different resections. This is known to vary between surgeons, and can also be influenced by patient selection and operative complexity. The aim of this article is to develop a structured, proficiency-based training program, with the facets of curricular design taken from a previously published framework of technical skills training, known as STATS (Systematic Training and Assessment in Technical Skills). There is a heavy emphasis on the use of simulated tissues to teach skills required. In order to enable objective assessment of performance, a procedure-specific global rating scale has been developed for assessment of performance during a laparoscopic anterior resection. An important part of the training program is to deliver team-based training for laparoscopic colorectal surgery. A key aspect of the curriculum is to focus on training the trainers, and it is with this advancement that opportunities shall evolve for surgical residents to learn these novel techniques, leading to their safe delivery with direct benefit to patients.