European Society of Coloproctology guideline on training in robotic colorectal surgery (2024)

Abstract

Robotic surgery has been utilized increasingly, including in colorectal surgery. Newer robotic platforms are coming onto the market, and more emphasis is being placed on the safety and adequate training of surgeons and theatre teams. Training in robotic colorectal surgery has not been standardized, and there are no agreed structured training and assessment methods. Some studies in minimally invasive surgery across specialities have shown that training curricula shortened the learning curve in minimally invasive surgery and, therefore, there is a greater need for guidance on training in robotic colorectal surgery based on up-to-date available evidence on the subject. The European Society of Coloproctology (ESCP) Guidelines Committee aimed to conduct a comprehensive literature review, assess currently available evidence and collate expert opinion on training in robotic colorectal surgery. Evidence was graded, and the recommendation was based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. When evidence is lacking expert opinion is considered, and the research gap is highlighted. The robotic guideline group addressed six topics with 15 research questions in the PICO format (patient/population, intervention, comparison and outcomes) and developed 11 recommendations. Most of the recommendations are based on a low or very low quality of evidence. Where the case benefits could be seen by indirect evidence or strong recommendations are unwarranted but made as good practice statements, they are made explicit by stating ‘expert opinion only’ without a GRADE level. The use of robotic surgery has steadily increased over the last years in both general surgery and colorectal surgery [1]. Approximately 1000 robotic-assisted procedures were performed worldwide in 2000; by 2018 this had increased to more than a million [2]. The advantages of robotic surgery were thought to be its suitability for confined spaces and complex operations such as rectal cancer surgery. The application and volume of practice continue to expand, and more robotic platforms are coming to the market [1, 3]. The projected global surgical robot market by 2025 is 275 billion USD. This is driven by innovation, growth in procedure volume and access to emerging markets [4]. It is crucial when introducing surgical techniques that patients should not come to harm, and surgical societies should have a leading role in appraising evidence and implementing surgical procedures [5, 6]. Evidence has suggested that training curricula shortened the learning curve in laparoscopic surgery and robotic surgery [7, 8]. However, there are variations in training components and assessments in different curricula [9]. It is therefore crucial to appraise the evidence on some key training components when implementing a structured training programme. This guideline is written and intended for surgeons, theatre teams, trainees, purchasers, local, regional and national policymakers, hospital leaderships, scientific societies, professional bodies for training and accreditation, and industry partners. The ESCP guidelines committee appointed project leads (ST, YM, DC) to curate this guideline. A steering group was formed with experts in robotic surgery, training and education, and guideline development with a common interest in improving training in robotic colorectal surgery. ESCP e-newsletters and social media announced a call for other working group members to participate in the guideline. The selection of final working group members was assessed based on the following set of criteria, and also keeping to the principle of equality, diversity and inclusion (EDI): 1. Appropriate and relevant clinical experience.2. A proven track record of scientific knowledge and research skills.3. International expertise and recognition or willingness to collaborate with diverse professionals and patients.4. Geographical distribution. The working group comprises colorectal surgeons, trainees, educators, expert robotic surgeons, surgical assist/allied health professionals familiar with robotic training, a and GRADE A in and expert guideline with the of this guideline The group with the to a to a set of to and questions to training in robotic colorectal surgery. The were not by or The group assessed the evidence with The guidance available GRADE that the and are and the of recommendation is based on This guideline development the ESCP guideline recommendations and the This guideline on the common training assessments and quality in robotic colorectal not robotic surgery in other specialities other minimally invasive techniques in colorectal surgery. 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