Background Right-sided colon cancer is now commonly treated by laparoscopic right hemicolectomy (LRH). The best procedure for mesentery dissection and nodal harvesting is still being debated. The purpose of this research is to compare intra-corporeal mesentery dissection (ICMD) with extra-corporeal mesentery dissection (ECMD) approaches and assess their impact on nodal harvest during LRH. Methods A retrospective analysis of 78 operative cases of LRH was performed. The patients were divided into two groups: those with ICMD (n = 30) and those with ECMD (n = 48). The total number of lymph nodes extracted was the primary outcome. The number of positive lymph nodes, length of hospital stay, and surgical complications were some of the secondary objectives. Results The total number of lymph nodes extracted in the ICMD was considerably higher (p = 0.02). Cancers located in the ascending colon were associated with more lymph nodes than tumours located in the cecum or hepatic flexure (p0.001). The two groups did not differ significantly regarding the median number of positive lymph nodes or length of hospital stay. Conclusion This study demonstrates that ICMD provides improved nodal yield compared to ECMD in LRH for right-sided colon cancer. Tumor location also impacts the nodal yield, with tumors in the ascending colon having the highest yield. Understanding the optimal mesentery dissection technique and nodal harvest can help improve the oncological outcomes. The use of robotic surgical equipment may further enhance the ICMD approach, especially for accessing retroperitoneal structures.
BackgroundCompetency‐based training (CBT) programs use procedure‐based assessments (PBAs) to evaluate trainees' abilities to perform specific procedures in clinical settings, similar to Entrustable Professional Activities (EPAs). PBAs help determine trainees' readiness for advanced training levels. However, there is limited evidence on implementing colorectal‐specific PBAs in surgical training schemes. This review aims to identify observed and perceived challenges to implementing PBAs in workplace settings.MethodsA scoping review following the Joanna Briggs Institute Protocol for Scoping Reviews (JBI‐ScR) was conducted. Eligible studies provided evidence on the implementation, feasibility, and challenges of PBAs in colorectal surgery, including various study designs from retrospective to prospective.ResultsOf the 80 screened studies, 75 were excluded based on exclusion criteria. Most of the included studies were conducted in national training institutions in the United Kingdom, assessing 778 colorectal procedures with specific PBAs. The main facilitators of implementing PBAs were structured assessments, focused assessors' training, and electronic forms usage.ConclusionThis review offers insight into the practicality and feasibility of implementing PBAs in colorectal surgery. Identified challenges include the need for adequate assessor training and the time‐consuming nature of the assessment. These findings could improve PBA implementation in colorectal surgery and enhance surgical education quality. However, the limited number of studies and existing literature heterogeneity call for more research to identify other gaps.
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