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The Lapco National Training Programme (NTP) in Laparoscopic Colorectal Surgery (LCS) is a unique training programme for Consultants in England. It was intended to train enough colorectal surgeons in LCS to a level of independence in routine colonic resections and to give all patients diagnosed with colorectal cancer in England access to an appropriately trained surgeon. LAPCO will shortly be coming to an end in March 2013 after 4 years of training activity. In 2006, less than 5% of colorectal resections were being undertaken laparoscopically. The latest HES data shows that this has risen to 40% (Hospital Episode Statistics 2012), which is a world leading figure of implementation. LAPCO has engaged with over 200 Colorectal Consultants in England. Over 1,800 theatre training sessions have been recorded on-line since March 2009. There are Lapco trainees and trainers in 61% of hospital trusts in England. There are compelling reasons why Lapco should continue beyond March 2013.
The National Training Programme (NTP) in Laparoscopic Colorectal Surgery (LAPCO) is funded by the National Cancer Action Team at the Department of Health to provide LCS training for consultants in England. It was established following the 2006 NICE Guidance (http://www.nice.org.uk/TA105) that stated that laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection.
The establishment of the LAPCO programme was led by Professor Sir Mike Richards, Director of National Cancer Action Team in 2007/2008. The programme comprises 11 training centres throughout England established geographically around the location of laparoscopic colorectal experts. National Coordination takes place in Plymouth, led by the National Clinical Lead Mark Coleman. In March 2009 Laura Langsford was appointed as the National Programme Manager, supported by a National Programme Administrator.
The education and research team at Imperial College, led by Professor George Hanna has been involved with the programme since its inception, and they initially projected that between 20-25 separate training cases would be required by each consultant before the standard of competency would be reached. These cases are undertaken either on an “in reach” basis (at the trainers hospital base) or on an “out reach” basis (at the trainees hospital base). After each training session, the trainee and the trainer complete their own on line Global Assessment Score (GAS) form through the LAPCO web site at www.lapco.nhs.uk. The GAS form breaks the procedure down into 13 stages, the trainee self assesses their performance, and the trainer completes their assessment which can be viewed by the trainee. Learning curve software has been incorporated into the web site to allow a trainees progress to be viewed by a separate procedure, or by total training recorded. Imperial College reported in May 2010 that the performance of mentored Lapco trainees produced better results than self-taught surgeons when comparing conversions and complication rates.
Once the volume of cases has been recorded the trainer recommends that the consultant is ready to be invited to undertake the “Sign Off” process. This involves the submission of 2 separate recorded cases on DVD which are anonomised and independently assessed by two assessors using the bespoke-designed L-CAT (Laparoscopic Colorectal Assessment Tool). A successful sign-off from the National Training Programme became a Peer Review Measure in March 2010. http://www.lapco.nhs.uk/peer-review.php
LAPCO currently has 42 trainees signed off, 41 trainees have been invited to sign off, 50 trainees are completing their training and are aiming to submit their DVDs by the end of 2012. A total of 67 trainers have provided over 1,800 GAS forms since clinical activity commenced in April 2009.
The programme offers hands-on training in the operating theatre. During training we have collected prospective data on clinical outcomes for patients operated on by surgeons in training. These data show that no harm comes to patients as a result of being operated on by surgeons in training. The hospital stay and complications rates are comparable to those published by acknowledged experts in LCS.
In 2012, Professor Peter Smith, Head of Health Policy and a mathematician at Imperial College, London conducted a detailed health economic analysis of the financial benefits of the programme. He concluded that, in terms of the avoidance of preventable negative outcomes and reduced hospital stay when comparing mentored to non-mentored training to disseminate a new technique across a health care system, that Lapco presented a potential financial benefit to the tax payer of over £11 million.
Summary - What has Lapco Achieved?
Prepared by Mark Coleman MD FRCS
LAPCO National Clinical Lead
LAPCO National Programme Manager
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