The rationale for an anastomosis workshop
How does a surgeon learn the craft of surgery? Learning on patients vs. learning in the lab
The old way of 'see one, do one, teach one' cannot teach you enough to achieve good results and patients are unlikely to do well whilst you hone your skills.
Learning on patients with good supervision can be effective but has disadvantages:
- You need enough prior skill to minimise the risk of harm to the patient
- You need sufficient time to do the operation without rushing
- The supervisor needs to be good at training and patient
- You may need to repeat the procedure several times before being confident enough to do it unsupervised or in an emergency setting
Performing an anastomosis is demanding. A leak-proof anastomosis must be constructed on a live patient, under changing conditions, sometimes with poor access, pressure of time and perhaps some bleeding. This is testing of technical skill and the operator needs to be confident of his or her ability. A failed or leaking anastomosis inevitably has serious consequences, mainly bleeding from or occlusion of an artery or leakage of bowel contents or urine in body cavities.
No computer simulation gives the real feel of performing an anastomosis, thus we believe the best way to learn anastomosis techniques is in a lab. There, principles can be taught and demonstrated and real anastomoses performed on animal material. Close formative supervision highlights faulty technique, pointing out why an anastomosis is unsatisfactory (recognition) and teaching ways of recovery (salvage).
Techniques can be repeated without time pressure and then anastomoses can be tested under water pressure and examined from the luminal surface. This cannot be done in life.
Anastomosis Training in Gynaecological Oncology
Gynaecological oncologists are the surgical members of the MDT dealing with gynaecological cancer. They first undergo specialist training in O&G, then subspecialist training in gynaecological oncology. Major operations performed in the specialty often need gastrointestinal procedures to achieve adequate cytoreduction, particularly in ovarian cancer. As the specialty has evolved, the gynaecological oncologists role has come to include managing bowel obstruction in recurrent cancers and long term complications of radiotherapy. The latter may need urinary diversion for vesico-vaginal fistula.
Gynaecological oncology fellows must therefore comprehend the indications and principles of resection, be able to perform anastomoses in large and small bowel and carry out ureteric repair, re-implantation and formation of an ileal conduit. Specialists in this field must therefore undergo formal and thorough training in these techniques, and to this end, all fellows are now required to attend a recognised Anastomosis Course.
The Cambridge Anastomosis Workshop has a long history of providing exactly what is needed, with high quality practical training in all mandatory areas and more.