International expert consensus on a structured approach to robotic multiport right hemicolectomy with complete mesocolic excision and intracorporeal anastomosis

Abstract

AIM: To develop and operationally define 'performance metrics' that characterize a reference approach to robotic multiport right hemicolectomy with complete mesocolic excision (CME) and intracorporeal anastomosis (ICA) and to obtain evidence supporting face and content validity through a consensus meeting. METHOD: Three expert colorectal surgeons with advanced minimally invasive surgical experience, a senior behavioural scientist and a colorectal surgeon with experience in performance metrics development formed the Metrics Group. Published guidelines, clinical evidence, training materials and unedited videos of robotic multiport right hemicolectomy were used to deconstruct the task-robotic right hemicolectomy with CME and ICA-into defined, observable performance units or metrics (i.e. procedure Phases, Steps, Errors and Critical Errors). The performance metrics were then subjected to detailed review by nine expert colorectal surgeons in a modified Delphi process. RESULTS: Performance metrics for robotic multiport right hemicolectomy with CME and ICA were deconstructed and described as 15 procedure phases with 124 steps, all of them associated with 146 errors and 136 critical errors. After the modified Delphi process, the agreed performance metrics consisted of 15 procedure phases and 125 steps, 150 errors and 139 critical errors. After discussion, agreed modifications to the metrics an international group of expert colorectal surgeons reached 100% consensus on them, thus providing evidence to support the face and content validity of the metrics. CONCLUSION: Robotic multiport right hemicolectomy with CME and ICA can be broken down into explicitly defined procedure phases and steps, with errors and critical errors known as performance metrics. We consider the metrics imperative for the development of a safe and structured training in robotic multiport right hemicolectomy with CME and ICA.