Bridging the training gap in laparoscopic colorectal surgery

In 2009, 53% of colorectal surgeons were performing a quarter of all colorectal procedures laparoscopically.1 2 A recent survey of colorectal surgery specialist trainees found that 85% of trainees did not feel ready to perform laparoscopic colorectal surgery at completion of specialist training (CCT).3 Therefore, despite the widespread availability of laparoscopic colorectal surgery, most colorectal trainees are not receiving enough training and experience to achieve competence in these techniques at CCT.

Ethicon Endo-Surgery currently sponsors two six month laparoscopic colorectal fellowships a year at 10 training centres in the UK. This will be reduced to six centres from April 2013,4 decreasing the number of fellowships from 20 to 12 a year. These fellowships provide high quality supervised training, exposing the trainee to a large number of operations within a relatively short time. However, these privately funded fellowships may not be sustainable in the longer term, given the current climate of austerity within the public and private sectors.

Intensive training and mentoring in laparoscopic colorectal surgery need to be provided within higher specialist training programmes. Consultants who have been through a laparoscopic colorectal fellowship themselves could become effective trainers in these techniques and their skills as trainers used to fill the training gap.5 We suggest that specific laparoscopic colorectal training posts are identified within each higher specialist rotation, and that senior colorectal trainees are given the opportunity to rotate through these posts to gain these skills and achieve competence before CCT.

In this way the future of laparoscopic colorectal training in the UK will be sustainable and available to all trainees within existing training programmes.