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. 2022 Aug:104:106766.
doi: 10.1016/j.ijsu.2022.106766. Epub 2022 Jul 13.

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

Islam Omar  1 , Karl Miller  2 , Brijesh Madhok  3 , Bassem Amr  4 , Rishi Singhal  5 , Yitka Graham  6 , Sjaak Pouwels  7 , Mohammad Abu Hilal  8 , Sandeep Aggarwal  9 , Irfan Ahmed  10 , Ali Aminian  11 , Basil Jaser Ammori  12 , Tan Arulampalam  13 , Altaf Awan  3 , José María Balibrea  14 , Aneel Bhangu  15 , Richard Raymond Brady  16 , Wendy Brown  17 , Manish Chand  18 , Ara Darzi  19 , Talvinder Singh Gill  20 , Ramen Goel  21 , Bussa R Gopinath  22 , Mark van Berge Henegouwen  23 , Jacques M Himpens  24 , David Daniel Kerrigan  25 , Misha Luyer  26 , Christian Macutkiewicz  27 , Julio Mayol  28 , Sanjay Purkayastha  19 , Raul Jacobo Rosenthal  29 , Scott Alan Shikora  30 , Peter Kenneth Small  31 , Neil James Smart  32 , Mark A Taylor  33 , Tehemton E Udwadia  34 , Tim Underwood  35 , Yirupaiahgari Ks Viswanath  36 , Neil Thomas Welch  37 , Steven D Wexner  29 , Michael Samuel James Wilson  38 , Des C Winter  39 , Kamal K Mahawar  40
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Free article

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

Islam Omar et al. Int J Surg. 2022 Aug.
Free article

Abstract

Background: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery.

Methods: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol.

Results: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count.

Conclusion: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.

Keywords: Ergonomics; Gastrointestinal surgery; Guidelines; Hepatobiliary; Laparoscopic surgery; Minimally invasive; Patient safety; Surgical training.

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