Laparoscopic CME

The laparoscopic CME programme is a training initiative by ESCP's European School of Coloproctology to promote laparoscopic complete mesocolic excision for colon cancer.

This has been made possible due to generous support from Johnson & Johnson and Medtronic.

Johnson Johnson logoMedtronic: Further, Together


Overall programme

Lap CME course progression diagram: selection, course, proctorship, independent practice

The overall programme aim is to enable skilled laparoscopic surgeons to become proficient in performing laparoscopic CME with central vascular ligation. This is achieved in several steps:

StageDescription
Selection Surgeons interested to participate in the programme will be selected according to selection criteria (see below).
Course Successful candidates will be invited to a 2-day hands-on course at the European Surgical Institute in Hamburg, Germany.
Proctorship Faculty members of the programme will visit the candidates in their hospitals and proctor them for a number of cases over a period.

Selection criteria

  • Teams of two surgeons per hospital (1 lead surgeon, 1 assistant)
  • Appropriate experience
    • Lead surgeon should be proficient in laparoscopic colorectal surgery
    • Minimum experience 50+ laparoscopic colorectal resections
    • Board certified (e.g. EBSQ, FRCS, Specialist in General and/or Coloproctology)
  • Institutional experience
    • Annual turnover of colon and rectum cancer of >50/year
    • Accessibility to appropriate laparoscopic infrastructure
  • Letter of support by Head of Department/Hospital

Course

  • Two-day course in Hamburg, with the aims:
    • To understand the evidence and rationale of CME
    • To master anatomy, operative planning and quality control
    • To achieve optimal results for individual patients
    • To learn operative technique
  • Hands-on operative training in high quality cadaveric models

Proctorship

  • Minimum of 2 x 2-day visits with the aim to perform 4 or more laparoscopic colon resections
  • Highly qualified faculty

Course structure

Venue: Johnson & Johnson Institute, Hummelsbütteler Steindamm 71, 22851 Norderstedt, Germany

Day 1 (17 December 2018)

TimeSession
10:00 - 10:30

Registration

A late start will allow participants to travel in the morning if they wish to do so.

10:30 - 10:50

Introduction

Purpose, overview of training programme, aim and structure of course, introduction of all participants, addressing personal aims, expectations, concerns.

10:50 - 11:20

Rationale for CME

Current level of evidence, limitations, rationale for CME and for laparoscopic approach.

11:20 - 11:45

Patient selection

Indications, workup, limitations (e.g. frailty, BMI, advanced disease, emergencies), patient selection during learning curve, levels of complexity (T stage, BMI, male…).

11: 45 - 12:10

Pathological outcomes and quality control

Mesocolic grading, benchmarks of outcomes (R1, lymphnode count, vessel lengths), resection bed, framework for auditing data, definition and extent of lymphadenectomy (D2 vs D3).

12:10 - 12:30

Perioperative management

Expected postoperative course, deviations, rescue strategies.

12:30 -12:45 Video vignette: Right hemicolectomy - structured video of right hemicolectomy
12:45 Lunch
13:40 Faculty meeting
14:00 - 15:00

Interactive module 1: Anatomy

All relevant anatomy, vascular (SMA and IMA territory), planes, orientation of colon and relationship to adjacent organs (e.g. ureters, kidneys, liver/ gallbladder/ spleen, stomach).

15:00 - 15:10 Video vignette: Vascular dissection of the right colon
15:10 - 16:00

Interactive module 2: CT interpretation (AMIGO)

Framework to identify vascular anatomy on arterial phase and portal venous phase CT scans (AMIGO), quality of CT, worked examples.

16:00 - 16:20 Break
16:20 - 17:10

Interactive module 3: Operative technique ascending/transverse colon

Didactic step-by-step description of technique, OR setup, patient position, port position, pitfalls and variations, critical views.

17:10 - 17:20 Video vignette: Intracorporeal anastomosis
17:20 - 18:00

Interactive module 4: Operative technique splenic flexure and left colon

Different techniques for anastomosis (extra- and intra-corporeal).

18:00 - 18:20

Interactive module 5: Crisis management

Examples of bad performance, recovery mechanisms.

18:20 Questions and closure
19:30 Course dinner

Day 2 (18 December 2018)

TimeSession
09:00 - 09:15

Welcome and reflection

A brief summary of day 1 and main learning points by interactive discussion with participants

09:15 - 09:30 Video vignette: Right hemicolectomy
09:30 - 09:45

Repetition of critical views: Right hemicolectomy

09:45 - 12:30

Wet Lab Session 1: Right hemicolectomy, extended right hemicolectomy

We have to think about how we can perform the operation without interrupting the left side too much….

12:30 Lunch
13:20 Faculty meeting
13:30 - 13:45 Video vignette: Left hemicolectomy
13:45 - 14:00

Repetition critical views: Left hemicolectomy

14:00 - 16:30

Wet Lab Session 2: Left hemicolectomy, splenic flexure resection

16:30 - 16:45

What next?

Explanation of proctorship programme, faculty allocation, 1st case selection process, formal issues.

16:45 Faculty meeting
17:00 Closure of course

Faculty

  • Adam Stearns (Norwich, UK)
  • Anders Bertelsen (Hillerød, Denmark)
  • Danilo Miskovic (London, UK)
  • Kristian Storli (Bergen, Norway)
  • Roland Croner (Magdeburg, Germany)
  • Stefan Benz (Boblingen, Germany)

Costs

  • The overall programme cost is €1800.00 per surgical team, excluding travel and accommodation for the two-day course in Hamburg
  • A reduced fee may be offered to teams from Albania, Azerbaijan, Belarus, Bosnia, Bulgaria, Egypt, Georgia, Macedonia, Moldova, Romania, Serbia, Turkey, Ukraine

Application process

Deadline for applications: 31 October 2018

Selection will be by online application. This will involve submission of the following:

  • Surgical log book of Laparoscopic Colorectal Resections
  • CV
  • Letter of support from Head of Department or Hospital Director

Applicants will also be asked to upload an unedited video of their most recent right hemicolectomy or anterior rectal resection. Please send the video by https://wetransfer.com/ to This email address is being protected from spambots. You need JavaScript enabled to view it.

The successful applicants will be contacted by the organising committee. The decision of the organising committee is final.

Please send your applications to: This email address is being protected from spambots. You need JavaScript enabled to view it.

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