Nationwide standardization of minimally invasive right hemicolectomy for colon cancer and development and validation of a video-based competency assessment tool (the Right study)
Authors: Grüter Alexander A J , Toorenvliet Boudewijn R , Belgers Eric H J , Belt Eric J T , van Duijvendijk Peter , Hoff Christiaan , Hompes Roel , Smits Anke B , van de Ven Anthony W H , van Westreenen Henderik L , Bonjer Hendrik J , Tanis Pieter J , Tuynman Jurriaan B ,   the Right collaborators group, van Aalten Sanne , Aarts Frits , Abis Gabor S A , Andeweg Caroline S , Baan Astrid H , Baeten Coen I M , Bastian Okan , Blauw Juliette , van Oud-Alblas Marjolein Blussé , den Boer Frank C , Boerma Evert-Jan G , Bolmers Matthijs D M , Bosker Robbert J I , de Castro Steve M M , Cherepanin Ivan M , Clermonts Stefan H E M , Coblijn Usha K , Demirkiran Ahmet , Derraze Yassmina , Dijkstra Robert , El-Massoudi Youssef , van Essen Jeroen A , Evers Danny J , Fabry Hans F J , Fransen Sofie , Goei Hauwy , Gooszen Jan , Govaert Johannes , Grimme Frederike A B , Grotenhuis Brechtje , den Hartog Anne , van Heek Tjarda , Heemskerk Jeroen , Heijnen Bob H M , van ‘t Hullenaar Cas D P , de Jong Gabie M , Jonker Frederik H W , Ketting Martin R , Kiewiet Jordy J S , Konsten Joop L M , Koopal Sietze A , Kortekaas Robert T J , Lagae Emmanuel , Lamme Bas , Lettinga Tanja , Lont Harold E , Lubbers Tim , Marsman Hendrik A , de Mey Dietrich J L , Moes Daan E , Neijenhuis Peter A , de Nes Lindsey C F , Nonner Joost , Omloo Jikke M T , Oosterling Steven J , Polle Bas , Pronk Apollo , Renger Rutger-Jan , de Roos Marnix A J , Rütter Jeroen E , van der Velden Arjan P Schouten , Bilgen Ernst J Spillenaar , Steller Ernst J A , Stockmann Hein B A C , Stoot Jan H M B , Sze Yuk K , Talsma Koen , Veltkamp Sanne C , Verhagen Tim , Verheijen Paul M , Vermaas Maarten , Vles Wouter J , de Vos tot Nederveen Cappel Robert J , Wasowicz Dareczka K , Westerterp Marinke , Wevers Kevin P , Witjes Carlijn D M , van Workum Frans T W E , Zijlstra Ronald J , Zimmerman David D E 
Published: December 2023

Abstract

Background
Substantial variation exists when performing a minimally invasive right hemicolectomy (MIRH) due to disparities in training, expertise and differences in implementation of innovations. This study aimed to achieve national consensus on an optimal and standardized MIRH technique for colon cancer and to develop and validate a video-based competency assessment tool (CAT) for MIRH.

Method
Statements covering all elements of MIRH were formulated. Subsequently, the Delphi technique was used to reach consensus on a standardized MIRH among 76 colorectal surgeons from 43 different centres. A CAT was developed based on the Delphi results. Nine surgeons assessed the same 12 unedited full-length videos using the CAT, allowing evaluation of the intraclass correlation coefficient (ICC).

Results
After three Delphi rounds, consensus (≥80% agreement) was achieved on 23 of the 24 statements. Consensus statements included the use of low intra-abdominal pressure, detailed anatomical outline how to perform complete mesocolic excision with central vascular ligation, the creation of an intracorporeal anastomosis, and specimen extraction through a Pfannenstiel incision using a wound protector. The CAT included seven consecutive steps to measure competency of the MIRH and showed high consistency among surgeons with an overall ICC of 0.923.

Conclusion
Nationwide consensus on a standardized and optimized technique of MIRH was reached. The CAT developed showed excellent interrater reliability. These achievements are crucial steps to an ongoing nationwide quality improvement project (the Right study).