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RACS ASC 2024

Vascular pedicle dissection time in laparoscopic colectomies as a novel marker of surgical skill.

Verbal Presentation

Verbal Presentation

3:03 pm

08 May 2024

Auditorium 4

THE MARK KILLINGBACK RESEARCH PAPER PRIZE SESSION

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Presentation Description

Institution: Multi centre NZ - Canterbury, Aotearoa New Zealand

Purpose Colorectal resections for benign and malignant diseases are common. Outcomes after surgery are dependent on patient, pathology and operative factors. Existing validated surgical skills scores are directly correlated to outcomes, but are time consuming. The vascular pedicle dissection time (VPDT) can be used as a ‘real-time’ marker to assess surgical skills. The aim of this study is to assess the VPDT and benchmark it against validated surgical skill score. Methodology A prospective multicentre study was performed in New Zealand including all laparoscopic colorectal resections. Patients were excluded if the vascular pedicle was taken open. Data was obtained about patient, operation and histology characteristics. The VPDT was calculated from retraction of the vascular pedicle to completion of that step of the operation. The competency assessment tool (CAT) was used and each laparoscopic video was scored by two independent colorectal surgeons. The CAT score was grouped into quartiles. Results 154 patients were included between December 2020 and November 2023, 74 (48.1%) right sided and 80 (51.9%) left sided resections. Median VPDT was significantly different between the different CAT score groups for left sided resection (lower 17min, middle 12 min, higher 11 min, p=0.075) but was not for right sided resections (lower 44min, middle 41 min, higher 25 min, p=0.005). There was no significant difference in R1 resection, anastomotic leak rate, occurrence of Clavien Dindo >3 complications or re-admission between the CAT groups. Conclusion This study was not powered to assess for surgical outcomes. It shows that the VPDT correlates to the CAT score and can be useful marker to assess a surgeon’s learning curve and skills.

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Miss Kirsten De Burlet - , Dr Isaac Tranter-Entwistle - , Mr Jeff Tan - , Mr Anthony Lin - , Mr Siraj Rajaratnam - , Mr Saxon Connor - , Prof Timothy Eglinton -