Amjad Parvaiz, Consultant Surgeon is responsible for all preceptoring in Portsmouth.
He has carried out / supervised approximately 400 laparoscopic colorectal resections in Portsmouth since September 2006, mostly for bowel cancer. Laparoscopic cancer resections are carried out without compromising oncologic principles using the same planes and sites of vascular ligation as in open surgery. Laparoscopic hybrid operations are not done. Approximately 90 % of resections can be completed laparoscopically; 90% have been training operations and this has been achieved with low morbidity and mortality even in “high risk” groups
o 3 models of training are available in Portsmouth: Preceptees may travel to be trained in Portsmouth with patients either brought from their base hospital or supplied by Portsmouth; or Amjad Parvaiz may travel to their base hospital to train on site. This will need to be discussed and agreed for each preceptee depending on their / our circumstances. For many a flexible approach will be best (below).
o It is anticipated that the majority of training days will be held in Queen Alexandra Hospital. However, it is probably beneficial to the trainee if 3 or more training days take place in the preceptees base hospital.
o Training takes place one day each week with 2 major resections per operating day.
o Preceptees arrive at 8.00 a.m on the day of surgery. The operating list and details of the patients undergoing surgery are discussed between Amjad Parvaiz and trainee. Brief review of relevant steps on DVD precede operations, including review of previous week’s training. Current training objectives are agreed.
o Training operations are modular. Module 1 includes positioning, access, vascular pedicle isolation and ligation. Module 2 includes mobilization of the colon, mesenteric division, delivery of tumour, bowel division and anastomosis. Module 3 is TME for rectal resection, not anticipated to be a part of the Training scheme unless the preceptee shows unusual aptitude.
o Debrief and DVD review: After preceptored operations the preceptee and preceptor review the operations helped by DVD recordings of the actual operation performed by the preceptee.
o Planning for next day’s training. Trainee leaves with the day’s DVDs to study.
o It is anticipated that preceptees will become competent in performing right hemicolectomies and high anterior resections independently by the end of preceptorship. This will require about 20 resections over 10 weeks.
o Competence will be assessed and advised on an ongoing basis.
Hands-on training in the operating theatre is supported by
§ Pre-Training familiarization and instruction in the use of laparoscopic kit and energy sources for cutting and haemostasis as well as in the use of laparoscopic stapling devices and clips.
§ Training DVDs demonstrating correct techniques for positioning the patient for laparoscopic colorectal resection, equipment setup and placement of ports, stepwise right hemicolectomy and high anterior resection.
§ Feedback of Preceptee’s own operating on DVD recordings
§ Team Training of your anaesthetist, scrub nurse, theatre sister and ODP to ensure that you will be well supported when you start independent operating in your own hospital. This occurs over 2 days and runs concurrently with your preceptoring.
§ Ongoing support and advice by telephone, e mail or by additional preceptoring in your own hospital.
§ Continuous feedback and fostering of appropriate skills in a modular training to promote competence and safe practice.
Preparation for Preceptorship in Portsmouth
o Approval / selection by the National Central Coordinating Office based in Plymouth
o Agreement that the theatre team comprising anaesthetist, and scrub nurse at a minimum attend Portsmouth for team training.
o Commitment from the Preceptees hospital management to support the development and provision of laparoscopic colorectal surgery in the base Trust by the preceptee on completion of the scheme by providing the necessary operating time, staff and kit.
o Compliance with requirements of the National Training Scheme e.g. lab based training or animal or cadaver training
o Observation of laparoscopic colorectal cancer resections: Preceptees are expected to observe 10 complete laparoscopic cancer resections. This can be done watching DVDs such as those supplied by Portsmouth National Training Centre, by attending Portsmouth to observe in theatre or by attending other surgeons doing laparoscopic colorectal resections elsewhere. It is crucial that operations are watched actively from setup to completion. The purpose of this observation phase is to gain an appreciation of the key steps of these operations and to appreciate the laparoscopic dissection planes.
o Trainees will attend Portsmouth on the basis of a written secondment agreement with their own Trust. This will allow operating privileges in Portsmouth and will encompass compliance with Occupational Health requirements, and Human Resources requirements,
o Compliance with Trust policies especially regarding Hospital Acquired Infections, clinical governance, and other surgically relevant issues.
Steps we will take to ensure that your training progresses
o We will contact Human Resources in Portsmouth NHS Trust so that they can liaise with you and with your Trust to ensure that documentation re health, hospital policies etc are in order and so that they can issue you with a contract (ideally a secondment from your own Trust) allowing you to operate in Portsmouth NHS Trust with an ID card and Parking permit
Steps you need to take
o We need to know as soon as possible whether the patients undergoing operations for your training will come from your Trust. That is the expected arrangement in the Training Programme. If that is not to be the case or if it is not possible Portsmouth can probably provide patients for your training. Please discuss with your Operational Manager. An “outreach” model of training whereby most of the training occurs in your base hospital is also possible.