Presentation Information
[ESY3-3]Challenges and training in Colorectal surgery
Kamales Prasitvarakul (Minimally Invasive Surgery Center Hatyai, Department of Surgery, Hatyai Hospital)
Background:Laparoscopic and robotic colorectal (CRC) surgery remain technically demanding due to limited instrument mobility, loss of depth perception, and reduced tactile feedback. These challenges highlight the importance of structured training and careful management of intra-operative complications.
Methods/Experience:This presentation reviews the learning curve and key training elements in laparoscopic CRC surgery, with illustrative videos of intraoperative complications and their management strategies will be demonstrated. Clinical outcomes demonstrate gradual improvement with experience: operative time decreases significantly after ~90 cases, anastomotic leakage rates decline after ~30 cases, and local recurrence rates fall below 10% after ~60 cases. Notably, the learning curve for oncological outcomes is longer than that for achieving safe surgical outcomes.
Discussion: Risk factors for complications arise from both patient and surgeon-related factors. Difficult cases include T4 or bulky tumors, prior midline laparotomy, obesity (BMI > 30), history of pelvic radiation, and low rectal cancer. Early complications and conversion rates depend heavily on surgical experience. To minimize risks, surgeons should: (1) understand pelvic planes and anatomy, (2) follow correct procedural steps, and (3) master stapling techniques for tissue division and anastomosis. Principles such as traction-counter traction, careful retraction, and direct visualization are critical to avoiding incorrect planes. Technical limitations remain in narrow pelvises and in cases of recurrent or previously irradiated disease, where fibrosis complicates venous dissection.
Conclusion:Training programs should acknowledge that complications encountered by fellows often reflect mentors' shortcomings. In colorectal cancer surgery, intraoperative bleeding is not only life-threatening but also associated with anastomotic leakage, infection, and higher local recurrence. Careful preoperative planning, anatomical mastery, and precise surgical technique are essential to reduce complications and improve patient outcomes.
Methods/Experience:This presentation reviews the learning curve and key training elements in laparoscopic CRC surgery, with illustrative videos of intraoperative complications and their management strategies will be demonstrated. Clinical outcomes demonstrate gradual improvement with experience: operative time decreases significantly after ~90 cases, anastomotic leakage rates decline after ~30 cases, and local recurrence rates fall below 10% after ~60 cases. Notably, the learning curve for oncological outcomes is longer than that for achieving safe surgical outcomes.
Discussion: Risk factors for complications arise from both patient and surgeon-related factors. Difficult cases include T4 or bulky tumors, prior midline laparotomy, obesity (BMI > 30), history of pelvic radiation, and low rectal cancer. Early complications and conversion rates depend heavily on surgical experience. To minimize risks, surgeons should: (1) understand pelvic planes and anatomy, (2) follow correct procedural steps, and (3) master stapling techniques for tissue division and anastomosis. Principles such as traction-counter traction, careful retraction, and direct visualization are critical to avoiding incorrect planes. Technical limitations remain in narrow pelvises and in cases of recurrent or previously irradiated disease, where fibrosis complicates venous dissection.
Conclusion:Training programs should acknowledge that complications encountered by fellows often reflect mentors' shortcomings. In colorectal cancer surgery, intraoperative bleeding is not only life-threatening but also associated with anastomotic leakage, infection, and higher local recurrence. Careful preoperative planning, anatomical mastery, and precise surgical technique are essential to reduce complications and improve patient outcomes.