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:

CSCG 3 rd Bowel Cancer Report Apr 2005 – March 2007

History of programme DoH and Cancer Action Team provide money for England Sept 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

36/45 80% response rate no plans to start want to start off and running ready to teach

Should be part of MDT discussion? Yes26/3770% No5/3714% No answer6/3716%

What % patients realistically are suitable?

Barriers to offering more lap surgery to your patients?

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 Appendix Right Hemi Left side Resection Animal Lab

BSS Course Core Skills Laparoscopy Appendix Right Hemi Left Side Resection Animal Lab CT1/2 ST3/4 ST 5/6 ST 7/8 Colorectal Trainee

Coordination Administration Contact Kate Creighton Griffiths Creighton- Teaching Faculty Incl. audit RITA committee