Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Br J Surg. 2024 Jan 3;111(1). doi: 10.1093/bjs/znad404.
Substantial variation exists when performing a minimally invasive right hemicolectomy (MIRH) due to disparities in training, expertise and differences in implementation of innovations. This study aimed to achieve national consensus on an optimal and standardized MIRH technique for colon cancer and to develop and validate a video-based competency assessment tool (CAT) for MIRH.
Statements covering all elements of MIRH were formulated. Subsequently, the Delphi technique was used to reach consensus on a standardized MIRH among 76 colorectal surgeons from 43 different centres. A CAT was developed based on the Delphi results. Nine surgeons assessed the same 12 unedited full-length videos using the CAT, allowing evaluation of the intraclass correlation coefficient (ICC).
After three Delphi rounds, consensus (≥80% agreement) was achieved on 23 of the 24 statements. Consensus statements included the use of low intra-abdominal pressure, detailed anatomical outline how to perform complete mesocolic excision with central vascular ligation, the creation of an intracorporeal anastomosis, and specimen extraction through a Pfannenstiel incision using a wound protector. The CAT included seven consecutive steps to measure competency of the MIRH and showed high consistency among surgeons with an overall ICC of 0.923.
Nationwide consensus on a standardized and optimized technique of MIRH was reached. The CAT developed showed excellent interrater reliability. These achievements are crucial steps to an ongoing nationwide quality improvement project (the Right study).
由于培训、专业知识的差异以及创新实施方式的不同，微创右半结肠切除术（MIRH）的操作存在很大差异。本研究旨在就结肠癌的最佳和标准化 MIRH 技术达成全国共识，并开发和验证一种基于视频的 MIRH 能力评估工具（CAT）。
制定了涵盖 MIRH 所有要素的陈述。随后，采用德尔菲技术，由来自 43 个不同中心的 76 名结直肠外科医生对标准化 MIRH 达成共识。基于德尔菲的结果开发了 CAT。9 名外科医生使用 CAT 评估了相同的 12 个未经编辑的全长视频，从而评估了组内相关系数（ICC）。
经过三轮德尔菲调查，对 24 项陈述中的 23 项达成了共识（≥80%的一致意见）。达成共识的陈述包括使用低腹腔内压、详细的解剖轮廓以完成完整的结肠系膜切除术和中央血管结扎、创建腔内吻合以及通过使用伤口保护器的 Pfannenstiel 切口提取标本。CAT 包括七个连续步骤，用于衡量 MIRH 的能力，并且外科医生之间的一致性很高，总体 ICC 为 0.923。
就标准化和优化的 MIRH 技术达成了全国共识。开发的 CAT 显示出良好的评分者间可靠性。这些成果是正在进行的全国质量改进项目（Right 研究）的重要步骤。
