Tahseen Qureshi

Virtual reality training and assessment in laparoscopic rectum surgery

Virtual‐reality (VR) based simulation techniques offer an efficient and low cost alternative to conventional surgery training. This article describes a VR training and assessment system in laparoscopic rectum surgery.

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease. The last decade has seen increasing numbers of surgeons trained to a high standard in minimally-invasive surgery. However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery. There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes. The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery (LCS) in the emergency setting. The literature is broadly divided by the underlying pathology; that is, inflammatory bowel disease, diverticulitis and malignant obstruction. There were no randomized trials and the majority of the studies were case-matched series or comparative studies. The overall trend was that LCS is associated with shorter hospital stay, par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection, the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.

Tailored robotic abdominoperineal resection with the da Vinci Xi for a re-growth of rectal tumour after complete clinical response - a video vignette.

Controversy persists as to the optimal surgical technique for abdominoperineal excision of the rectum (APER).(1–3). Extra-levator dissection has been advocated by certain groups who claim to have better R0 resection rates and a reduced incidence of perforation (4–6). However, such a radical approach may result in poorer wound healing, prolonged hospital stay and increased wound morbidity (7). In this operative video we present an abdominoperineal resection using the da Vinci Xi on a 34-year-old lady who had a low rectal adenocarcinoma. This article is protected by copyright. All rights reserved.

Evolution in surgical training: what can we learn from professional coaches and elite athletes?:

Surgical training has always involved an apprenticeship between trainer and trainee. The concept of a learning curve in the ‘craft specialities’ and the relationship between the number of cases performed and surgical complications are well known. Historically, a transition from assistant through supervised operating to independent operator was made on the simple basis of case volume and attendance in theatre. Yet, the advent of laparoscopy has provided an opportunity to evolve traditional training techniques, which have been primarily based on quantity over quality, and perhaps redefine the roles of trainer and trainee. Laparoscopic surgery has many benefits in terms of patient outcomes. But in addition to these, there are the advantages for surgical training as laparoscopy lends itself for use as a remote teaching tool. There have been many studies investigating the optimal methods of training to minimise the learning curve, but what has rarely been addressed is the changing relationship between trainer and trainee. Surgical training can be categorised into two distinct components: (1) acquisition of dexterity; and (2) pattern recognition and decision-making. While the first of these requires physical practice, the latter can be part-learnt outside the operating theatre to some extent. For example, reviewing recorded laparoscopic procedures in an analytical manner as part of surgical training allows for the conscious increase in pattern recognition and therefore operative decision-making. Surgical decision-making can be further divided into intuitive or analytical, depending on the context of the procedure. However, both processes rely on experience and pattern recognition. Intimate analysis of different operative scenarios between trainer and trainee can therefore contribute to shortening the learning curve. The ‘surgical coach’

Robotic vascular ligation, medial to lateral dissection and splenic flexure mobilization for rectal cancer - a video vignette

a pursestring suture and replaced in the abdomen. A stapled coloanal anastomosis was achieved with a CDH 29 circular stapler. A covering ileostomy was made. The robotic console time was 120 min with an estimated blood loss of 50 ml. The patient was discharged on postoperative day 5 without any significant morbidity. Sphincter-saving procedures for low rectal cancers, although technically challenging, are possible with the advanced robotic systems. The da Vinci Xi system makes multiquadrant surgery possible in the same docking position, which facilitates complete splenic flexure mobilization for better colonic length, necessary for a tension-free anastomosis. Further, well-designed trials need to be conducted to evaluate the long-term functional and oncological outcomes of Robotic ISR.

Robotic TME for a T4 rectal cancer after radiotherapy - a video vignette

Neoadjuvant treatment plays an important role in the downstaging of rectal cancer. Some patients who are treated in this way will develop a complete clinical response (1). The adoption of a “watch and wait” policy for patients who have undergone complete clinical response is now accepted in many centres (2,3). An intensive follow-up protocol, including clinical, endoscopic and magnetic resonance imaging (MRI) assessment every four months for the first 2 years is recommended (3). Studies have shown that despite some excellent responses to the initial treatment, up to 30% of patients will develop a regrowth requiring surgical resection (1–3). This article is protected by copyright. All rights reserved.