European consensus on the standardization of robotic total mesorectal excision for rectal cancer.
AIM
Surgery for rectal cancer is challenging for both technical and anatomical reasons. The European Academy of Robotic Colorectal Surgery (EARCS) provides a competency-based training programme through a standardized approach. However, there is no consensus on technical standards for robotic surgery when used during surgery for rectal cancer. The aim of this consensus study was to establish operative standards for anterior resection incorporating total mesorectal excision (TME) using robotic techniques, based on recommendations of expert European colorectal surgeons.


METHOD
A Delphi questionnaire with a 72-item statement was sent through an electronic survey tool to 24 EARCS faculty members from 10 different countries who were selected based on expertise in robotic colorectal surgery. The task was divided into theatre setup, colonic mobilization and rectal dissection, and each task area was further divided into several subtasks. The levels of agreement (A* > 95% agreement, A > 90%, B > 80% and C > 70%) were considered adequate while agreement of < 70% was considered inadequate. Once consensus was reached, a draft document was compiled and sent out for final approval.


RESULTS
The average length of experience of robotic colorectal surgery for participants in this study was 6 years. Initial agreement was 87%; in nine items, it was < 70%. After suggested modifications, the average level of agreement for all items reached 94% in the second round (range 0.75-1).


CONCLUSION
This is the first European consensus on the standardization of robotic TME. It provides a baseline for technical standards and structured training in robotic rectal surgery.
['Miskovic|D|D|', 'Ahmed|J|J|', 'Bissett-Amess|R|R|0000-0001-6342-5178', 'Gómez Ruiz|M|M|0000-0002-0848-4682', 'Luca|F|F|0000-0001-6346-1769', 'Jayne|D|D|0000-0002-8725-3283', 'Figueiredo|N|N|0000-0002-5582-0933', 'Heald|R J|RJ|', 'Spinoglio|G|G|0000-0002-9985-2208', 'Parvaiz|A|A|', '|||']
D000328:Adult D000368:Aged D032921:Consensus D003697:Delphi Technique D005060:Europe D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D000078542:Proctectomy D012004:Rectal Neoplasms D012015:Reference Standards D065287:Robotic Surgical Procedures
Consensus rectal cancer technical standard robotic surgery