Domains of four-step technique training program for laparoscopic colorectal surgery

Many surgeons have begun learning about colorectal surgery using laparoscopy rather than laparotomy. The domains of four-step technique training program (DOF) for laparoscopic colorectal surgery have been designed and implemented by our institute since 2011, and they are expected to provide a safe and effective program for trainees with limited experience in laparoscopic colorectal surgery.

The DOF were established with standard surgical procedures, a four-step technique, and learning passports using point credits after the procedure was completed. Patients who underwent minimally invasive colorectal resection at the Chang Gung Memorial Hospital between January 2013 and April 2019 were enrolled.

Overall, 2604 and 478 patients were enrolled in the non-training and training groups, respectively. Multivariable logistic regression analysis revealed that the postoperative short-term outcomes were not significantly associated with the training or non-training groups. However, the training group had a significantly longer operative time than the non-training group in the linear regression model. Once the trainee passed the proficiency point (passed 100 points or 30 cases), no significant difference in postoperative short-term outcomes was found between the patients in the non-training and training groups that underwent the entire surgery performed by the trainee.

When patients' safety was evaluated in the training cases under the DOF, no higher rates of postoperative morbidity and mortality were found compared to those in cases performed by experienced surgeons. Additionally, trainees who passed the proficiency point during DOF could safely perform the entire laparoscopic colorectal surgery under supervision without further adverse effects on the patients.