Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey.
Colorectal Dis. 2021 Dec;23(12):3141-3151. doi: 10.1111/codi.15857. Epub 2021 Aug 27.
The aim of this study is to demonstrate our video training tool developed to teach and standardize complete mesocolic excision (CME) for right-sided colon cancer and also to present our long-term oncological outcomes.
Educational narrative videos were produced to demonstrate the technical steps of CME. First, a three-dimensional animation video was prepared. Then cadaveric dissections were recorded in a step-by-step fashion, following the sequences of open and minimally invasive surgery. These were followed by videos of real-life demonstrations of surgical procedures, enhanced by superimposed animations of key anatomical structures. In order to demonstrate the impact of this training module on outcomes of patients undergoing CME, we retrospectively queried data from before (2005-2010) and after (2011-2019) implementation of standardized CME in our practice.
A total of 180 consecutive patients underwent right hemicolectomy between 2005 and 2019. Fifty-four patients underwent surgery before and 126 patients after CME principles were elaborated and standardized. Of those patients who had surgery after the training module, 58 (46%) underwent open surgery and 68 (54%) underwent laparoscopic colectomy. Demographics, perioperative parameters and morbidity were comparable between the groups. The 5-year overall and disease-free survival rates were significantly improved after implementation of CME training (p = 0.059 and p = 0.041, respectively). Also, 5-year overall and disease-free survival rates for all patients were considerably better than our reported national outcomes.
Our comprehensive step-by-step training video module for the CME technique demonstrates surgical anatomical planes and important vascular structures and variations. The video also helps standardization of the CME technique and should contribute to improved histopathological and oncological outcomes.
本研究旨在展示我们开发的用于教授和规范右半结肠癌完整结肠系膜切除术（CME）的视频培训工具，并介绍我们的长期肿瘤学结果。
制作了教育叙事视频，以演示 CME 的技术步骤。首先，制作了一个三维动画视频。然后，按照开腹和微创手术的顺序，一步一步地记录尸体解剖过程。之后，我们录制了真实手术过程的演示视频，并通过关键解剖结构的动画叠加来增强视频效果。为了展示该培训模块对接受 CME 的患者结果的影响，我们回顾性地查询了我们实践中实施标准化 CME 前后（2005-2010 年和 2011-2019 年）的数据。
共有 180 例连续患者在 2005 年至 2019 年期间接受了右半结肠切除术。54 例患者在 CME 原则制定和标准化之前接受了手术，126 例患者在之后接受了手术。在接受培训模块后的患者中，58 例（46%）接受了开放手术，68 例（54%）接受了腹腔镜结肠切除术。两组患者的人口统计学、围手术期参数和发病率无差异。实施 CME 培训后，5 年总生存率和无病生存率显著提高（分别为 p=0.059 和 p=0.041）。此外，所有患者的 5 年总生存率和无病生存率均明显优于我们报告的全国结果。
我们的 CME 技术全面的分步培训视频模块展示了手术解剖平面和重要的血管结构和变异。该视频还有助于 CME 技术的标准化，并应有助于改善组织病理学和肿瘤学结果。
