Editorial
Teaching of Laparoscopic Surgery Colorectal. The Lapco Model
Formación en cirugía laparoscópica colorrectal. El modelo Lapco
a Lead Clinician, Lapco National Training Programme in Laparoscopic Colorectal Surgery, United Kingdom
b Consultant Surgeon, Derriford Hospital, Plymouth, United Kingdom
c Professor of Surgery, Royal Surrey County Hospital, Guildford, United Kingdom
d Director of Minimal Access Therapy Training Unit, Guildford, United Kingdom
e President of the Association of Laparoscopic Surgeons of Great Britain and Ireland, Ireland
Read
4709
Timeswas read the article
1018
Total PDF
3691
Total HTML
Share statistics
array:23 [ "pii" => "S2173507713001609" "issn" => "21735077" "doi" => "10.1016/j.cireng.2013.10.010" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "1018" "copyright" => "AEC" "copyrightAnyo" => "2012" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Cir Esp. 2013;91:279-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1955 "formatos" => array:3 [ "EPUB" => 16 "HTML" => 1445 "PDF" => 494 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0009739X13000031" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2012.11.005" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "1018" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Cir Esp. 2013;91:279-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3788 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 2908 "PDF" => 868 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Formación en cirugía laparoscópica colorrectal. El modelo Lapco" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "280" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Teaching of laparoscopic surgery colorectal. The Lapco model" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mark Coleman, Tim Rockall" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Mark" "apellidos" => "Coleman" ] 1 => array:2 [ "nombre" => "Tim" "apellidos" => "Rockall" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507713001609" "doi" => "10.1016/j.cireng.2013.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713001609?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X13000031?idApp=UINPBA00004N" "url" => "/0009739X/0000009100000005/v1_201305021703/S0009739X13000031/v1_201305021703/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507713001671" "issn" => "21735077" "doi" => "10.1016/j.cireng.2013.10.017" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "1034" "copyright" => "AEC" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Cir Esp. 2013;91:281-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5706 "formatos" => array:3 [ "EPUB" => 14 "HTML" => 5002 "PDF" => 690 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Adenocarcinoma of the Anal Canal. Narrative Review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "281" "paginaFinal" => "286" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adenocarcinoma del canal anal. Revisión de conjunto" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 675 "Ancho" => 901 "Tamanyo" => 212948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Disorganized and infiltrative tubular gland proliferation underlying non-neoplastic squamous anal mucosa on the endoscopic biopsy of an ADC of the anal glands (hematoxylin and eosin ×10).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Ferrer Márquez, Francisco Javier Velasco Albendea, Ricardo Belda Lozano, María del Mar Berenguel Ibáñez, Ángel Reina Duarte" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Ferrer Márquez" ] 1 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Velasco Albendea" ] 2 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Belda Lozano" ] 3 => array:2 [ "nombre" => "María del Mar" "apellidos" => "Berenguel Ibáñez" ] 4 => array:2 [ "nombre" => "Ángel" "apellidos" => "Reina Duarte" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X13000602" "doi" => "10.1016/j.ciresp.2013.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X13000602?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713001671?idApp=UINPBA00004N" "url" => "/21735077/0000009100000005/v1_201311210034/S2173507713001671/v1_201311210034/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Teaching of Laparoscopic Surgery Colorectal. The Lapco Model" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "280" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mark Coleman, Tim Rockall" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Mark" "apellidos" => "Coleman" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] ] ] 1 => array:4 [ "nombre" => "Tim" "apellidos" => "Rockall" "email" => array:1 [ 0 => "tim.rockall@btinternet.com" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Lead Clinician, Lapco National Training Programme in Laparoscopic Colorectal Surgery, United Kingdom" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Consultant Surgeon, Derriford Hospital, Plymouth, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Professor of Surgery, Royal Surrey County Hospital, Guildford, United Kingdom" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Director of Minimal Access Therapy Training Unit, Guildford, United Kingdom" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "President of the Association of Laparoscopic Surgeons of Great Britain and Ireland, Ireland" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Formación en cirugía laparoscópica colorrectal. El modelo Lapco" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The LAPCO program is a training program for laparoscopic colorectal surgery (LCS) for specialists in colorectal surgery developed in England. The aim of this program is to introduce LCS in a safe way in all the health system. As a consequence, at present LCS is performed in 87% of hospitals in England, and according to the Hospital Episode Statistics, 40% of elective colorectal resections are performed laparoscopically or assisted by laparoscopy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2006, before Lapco was instituted, the National Institute for Health Clinical Excellence for England and Wales (NICE) of the government issued a technological guideline recommending the use of LCS, performed by adequately trained surgeons, as an alternative for appropriately selected patients. At that time, it was estimated that 5% of surgeons had received training in LCS, and therefore the guideline was postponed for 3 years, until September 2009.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Subsequently, this dispensation was extended until September 2010. With the aim of solving this national shortage of surgeons trained in LCS, the Health Department of England instituted in 2007 a National Training Program (NTP) for LCS (Lapco). The program was designed to give a practical training in LCS to colorectal surgeons in England. Ten regional centers with “training experts” were designated to provide training in LCS, with a national coordinator and a department of evaluation and education research.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Lapco program includes cadaver courses, and hands-on training and structured assessment in the operating room. The NTP is centered on providing a practical training in this area of surgery where the specialist is directly supervised and tutored by an expert in LCS. The NTP considered that in order to obtain an adequate competence level to perform these operations independently, the surgeon should perform at least 20 cases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In order to collect the data on the clinical results obtained and the competence learning curve, each training case is followed by the registration of a validated global assessment form (GAS) on-line in the webpage (<a href="http://www.lapco.nhs.uk/">www.lapco.nhs.uk</a>). The forms are different for the trainer and the trainee.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The surgeon in training completes the form after the surgery, including subsequent results of morbidity and mortality. In the GAS forms, each of the LCS procedures are divided into 13 key steps, accorded by a panel of expert trainer surgeons of Lapco. In these key steps different aspects of LCS are included, such as preparation of the operating room, trocar insertion, dissection and division of the vascular pedicle, intestinal resection and anastomosis. Trainer and trainee evaluate the proficiency in each of these steps in a non-critical way, with a score of 1 to 6, in which 1 means “this step was performed by the trainer” to 6, which means “competent, could not have done it better”. Since the program started in January 2008, 152 specialist colorectal surgeons in England have participated in the NTP and over 1800 cases have been registered, by the activity in the GAS forms. In regions with a shortage of specialized surgeons trained in LCS new training centers and trainers have been found.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the provisional analysis of the GAS forms data from 339 cases performed by 38 trainees and supervised by 20 trainers were included. There were 130 right colon resections and 185 left colon resection (24 non-specified cases). Cancer was the main diagnosis in 268 cases. Conversion to open surgery was needed in 23 cases (7%), 50 patients had surgical or medical complications (15%), 9 of which had anastomotic leaks (3%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Two patients died in hospital (0.5%). Both univariate and multivariate regression analysis showed that male sex and left colon resections are independent factors for conversion, but not the experience of the trainee. This result was confirmed by the CUSUM analysis that showed that the goal rate of conversion of 5% was obtained from the beginning of the training phase. However, the scores obtained in the analysis show that there is a gain in the acquired competence up to the twentieth procedure performed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">These results clearly support the evidence that NTP is effective in allowing surgeons in training to advance in the development of their capabilities in the technique. The results obtained in patients are comparable to those obtained by experienced surgeons during the training period. This contrasts directly with prior non-structured reports on training that suggested a significant increase in conversion rates and morbidity in the early stages of the learning curve.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The GAS form also provides a structured framework to enhance the postoperative debriefing between trainer and trainee.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Completion of the form can be done in an average of 3.3<span class="elsevierStyleHsp" style=""></span>min and most trainees and trainers consider it a valuable element in the training process. No specific training is needed and it can be easily adapted for use in other surgical specialties and in other degrees of non-specialized training. In contrast with most of the methods employed at present in the UK to evaluate surgical training, the GAS form provides a validated means of evaluation of specific surgical ability and the proficiency gain curve acquired by the surgeons in training. Lapco also provides a course entitled “Train the trainer” that allows evaluation and improvement of the capabilities of our expert trainers. Fifty of the 67 trainers participating in Lapco have participated in this course.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We now live in a time when bad results cannot be accepted only because we are not familiarized with a new surgical technique; this happened in the nineties with some new laparoscopic procedures such as cholecystectomy. The NTP has been successful in providing an efficient training at the same time as good clinical results in patients. We can conclude that Lapco offers a new paradigm for surgical training that should be considered for all areas of surgery where new techniques or technology is used.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Coleman M, Rockall T. Formación en cirugía laparoscópica colorrectal. El modelo Lapco. Cir Esp. 2013;91:279–280.</p>" ] 1 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The 2 authors work in the UK National Health Service.</p>" "identificador" => "fn1" ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack68426" "titulo" => "Acknowledgements" "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">To Professor George Hanna, Imperial College, London (UK).</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009100000005/v1_201311210034/S2173507713001609/v1_201311210034/en/main.assets" "Apartado" => array:4 [ "identificador" => "7420" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009100000005/v1_201311210034/S2173507713001609/v1_201311210034/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713001609?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 32 | 5 | 37 |
| 2024 September | 71 | 17 | 88 |
| 2024 August | 44 | 10 | 54 |
| 2024 July | 68 | 13 | 81 |
| 2024 June | 45 | 5 | 50 |
| 2024 May | 45 | 6 | 51 |
| 2024 April | 54 | 11 | 65 |
| 2024 March | 44 | 3 | 47 |
| 2024 February | 44 | 7 | 51 |
| 2024 January | 67 | 3 | 70 |
| 2023 December | 65 | 4 | 69 |
| 2023 November | 48 | 4 | 52 |
| 2023 October | 66 | 1 | 67 |
| 2023 September | 23 | 1 | 24 |
| 2023 August | 25 | 3 | 28 |
| 2023 July | 27 | 6 | 33 |
| 2023 June | 57 | 1 | 58 |
| 2023 May | 52 | 5 | 57 |
| 2023 April | 50 | 1 | 51 |
| 2023 March | 38 | 2 | 40 |
| 2023 February | 27 | 4 | 31 |
| 2023 January | 46 | 8 | 54 |
| 2022 December | 37 | 5 | 42 |
| 2022 November | 37 | 10 | 47 |
| 2022 October | 23 | 4 | 27 |
| 2022 September | 35 | 10 | 45 |
| 2022 August | 41 | 8 | 49 |
| 2022 July | 23 | 12 | 35 |
| 2022 June | 27 | 8 | 35 |
| 2022 May | 25 | 8 | 33 |
| 2022 April | 21 | 6 | 27 |
| 2022 March | 54 | 23 | 77 |
| 2022 February | 34 | 13 | 47 |
| 2022 January | 60 | 10 | 70 |
| 2021 December | 34 | 11 | 45 |
| 2021 November | 31 | 11 | 42 |
| 2021 October | 38 | 13 | 51 |
| 2021 September | 37 | 12 | 49 |
| 2021 August | 36 | 10 | 46 |
| 2021 July | 20 | 14 | 34 |
| 2021 June | 20 | 12 | 32 |
| 2021 May | 39 | 8 | 47 |
| 2021 April | 94 | 27 | 121 |
| 2021 March | 51 | 16 | 67 |
| 2021 February | 34 | 23 | 57 |
| 2021 January | 43 | 13 | 56 |
| 2020 December | 37 | 8 | 45 |
| 2020 November | 36 | 26 | 62 |
| 2020 October | 37 | 6 | 43 |
| 2020 September | 28 | 11 | 39 |
| 2020 August | 28 | 8 | 36 |
| 2020 July | 28 | 15 | 43 |
| 2020 June | 32 | 12 | 44 |
| 2020 May | 29 | 15 | 44 |
| 2020 April | 17 | 5 | 22 |
| 2020 March | 30 | 8 | 38 |
| 2020 February | 24 | 7 | 31 |
| 2020 January | 41 | 12 | 53 |
| 2019 December | 43 | 14 | 57 |
| 2019 November | 32 | 16 | 48 |
| 2019 October | 29 | 23 | 52 |
| 2019 September | 33 | 6 | 39 |
| 2019 August | 26 | 7 | 33 |
| 2019 July | 48 | 16 | 64 |
| 2019 June | 55 | 14 | 69 |
| 2019 May | 163 | 44 | 207 |
| 2019 April | 57 | 11 | 68 |
| 2019 March | 13 | 3 | 16 |
| 2019 February | 21 | 5 | 26 |
| 2019 January | 11 | 4 | 15 |
| 2018 December | 9 | 2 | 11 |
| 2018 November | 14 | 10 | 24 |
| 2018 October | 13 | 8 | 21 |
| 2018 September | 19 | 0 | 19 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 19 | 2 | 21 |
| 2018 June | 8 | 1 | 9 |
| 2018 May | 7 | 1 | 8 |
| 2018 April | 6 | 1 | 7 |
| 2018 March | 6 | 0 | 6 |
| 2018 February | 5 | 3 | 8 |
| 2018 January | 15 | 5 | 20 |
| 2017 December | 4 | 6 | 10 |
| 2017 November | 7 | 0 | 7 |
| 2017 October | 11 | 3 | 14 |
| 2017 September | 10 | 3 | 13 |
| 2017 August | 16 | 1 | 17 |
| 2017 July | 10 | 2 | 12 |
| 2017 June | 15 | 6 | 21 |
| 2017 May | 16 | 1 | 17 |
| 2017 April | 16 | 1 | 17 |
| 2017 March | 14 | 2 | 16 |
| 2017 February | 5 | 2 | 7 |
| 2017 January | 9 | 3 | 12 |
| 2016 December | 8 | 9 | 17 |
| 2016 November | 13 | 4 | 17 |
| 2016 October | 42 | 3 | 45 |
| 2016 September | 23 | 8 | 31 |
| 2016 August | 15 | 6 | 21 |
| 2016 July | 8 | 3 | 11 |
| 2016 June | 22 | 8 | 30 |
| 2016 May | 15 | 14 | 29 |
| 2016 April | 17 | 13 | 30 |
| 2016 March | 16 | 22 | 38 |
| 2016 February | 8 | 13 | 21 |
| 2016 January | 9 | 9 | 18 |
| 2015 December | 12 | 9 | 21 |
| 2015 November | 19 | 12 | 31 |
| 2015 October | 22 | 16 | 38 |
| 2015 September | 22 | 10 | 32 |
| 2015 August | 13 | 4 | 17 |
| 2015 July | 12 | 1 | 13 |
| 2015 June | 2 | 0 | 2 |
| 2015 May | 13 | 4 | 17 |
| 2015 April | 20 | 10 | 30 |
| 2015 March | 14 | 5 | 19 |
| 2015 February | 15 | 4 | 19 |
| 2015 January | 23 | 3 | 26 |
| 2014 December | 34 | 12 | 46 |
| 2014 November | 27 | 5 | 32 |
| 2014 October | 19 | 4 | 23 |
| 2014 September | 17 | 3 | 20 |
| 2014 August | 15 | 3 | 18 |
| 2014 July | 19 | 5 | 24 |
| 2014 June | 13 | 3 | 16 |
| 2014 May | 9 | 4 | 13 |
| 2014 April | 15 | 3 | 18 |
| 2014 March | 8 | 2 | 10 |
| 2014 February | 5 | 4 | 9 |
| 2014 January | 17 | 6 | 23 |
| 2013 December | 14 | 4 | 18 |
| 2013 November | 4 | 2 | 6 |
Show all
