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. 2024 Jan 3;111(1):znad404.
doi: 10.1093/bjs/znad404.

Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)

Alexander A J Grüter  1   2 , Boudewijn R Toorenvliet  3 , Eric H J Belgers  4 , Eric J T Belt  5 , Peter van Duijvendijk  6 , Christiaan Hoff  7 , Roel Hompes  8 , Anke B Smits  9 , Anthony W H van de Ven  10 , Henderik L van Westreenen  11 , Hendrik J Bonjer  1 , Pieter J Tanis  8   12 , Jurriaan B Tuynman  1 ; Right collaborators group
Collaborators, Affiliations

Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)

Alexander A J Grüter et al. Br J Surg. .

Abstract

Background: 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.

Method: 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).

Results: 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.

Conclusion: 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).

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Conflict of interest statement

The authors declare there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the Delphi process
Fig. 2
Fig. 2
Video-based competency assessment tool of minimally invasive right hemicolectomy, step 3
Fig. 3
Fig. 3
Scatterplot of the average competency assessment tool (CAT) scores per rater and average score of all raters per video with the cutoff value of 2.7
See this image and copyright information in PMC

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