European Robotic Surgery Consensus (ERSC): Protocol for the development of a consensus in robotic training for gastrointestinal surgery trainees.

BACKGROUND: The rapid adoption of robotic surgical systems across Europe has led to a critical gap in training and credentialing for gastrointestinal (GI) surgeons. Currently, there is no existing standardised curriculum to guide robotic training, assessment and certification for GI trainees. This manuscript describes the protocol to achieve a pan-European consensus on the essential components of a comprehensive training programme for GI robotic surgery through a five-stage process. METHODS AND ANALYSIS: In Stage 1, a Steering Committee, consisting of international experts, trainees and educationalists, has been established to lead and coordinate the consensus development process. In Stage 2, a systematic review of existing multi-specialty robotic training curricula will be performed to inform the formulation of key position statements. In Stage 3, a comprehensive survey will be disseminated across Europe to capture the current state of robotic training and identify potential challenges and opportunities for improvement. In Stage 4, an international panel of GI surgeons, trainees, and robotic theatre staff will participate in a three-round Delphi process, seeking ≥ 70% agreement on crucial aspects of the training curriculum. Industry and patient representatives will be involved as external advisors throughout this process. In Stage 5, the robotic training curriculum for GI trainees will be finalised in a dedicated consensus meeting, culminating in the production of an Explanation and Elaboration (E&E) document. REGISTRATION DETAILS: The study protocol has been registered on the Open Science Framework (https://osf.io/br87d/).

Chronic groin pain following inguinal hernia repair in the laparoscopic era: Systematic review and meta-analysis.

BACKGROUND: The impact of laparoscopic inguinal hernia repair (IHR) on chronic groin pain (CGP) prevalence, risk and daily activities compared to open IHR is still unclear. METHODS: A meta-analysis of randomised controlled trials comparing CGP rates in laparoscopic and open IHR was performed. RESULTS: 22 trials were included. CGP prevalence decreases significantly 1-2 years post-op and reaches rates as low as 4.69% (laparoscopic) and 6.91% (open) at >5 years. There is a significantly lower risk of CGP following totally extraperitoneal (TEP) than open mesh repair at all follow-up periods (p < 0.05) except for >5 years (p = 0.32). The same trend is not seen when compared to open non-mesh repair or for transabdominal pre-peritoneal repair (TAPP). There is no difference between techniques when CGP is described as moderate and/or affecting daily activities (p = 0.08). CONCLUSION: CGP rates continue to decrease at >5 years follow up. TEP consistently results in a reduction in CGP rates compared to open mesh repair however, this is not functionally significant.

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery.

AIM: There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS: Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS: All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION: These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.