Efficacy of the "critical view/open book" concept for implementing standardized right hemicolectomy with complete mesocolic excision—results from a series of minimally invasive surgical training courses

BACKGROUND: Since the introduction of right hemicolectomy with complete mesocolic excision (CME) the implementation of minimally invasive CME as standard of care still remains challenging. Among several established guidelines for minimally invasive CME, the "critical view/open book" concept has been developed to provide a stepwise standardization with safety checkpoints for teaching purposes. The present study evaluates this concept during its practical application in a large series of surgical training courses. METHODS: In this prospective observational study, seven consecutive 2-day surgical training courses based on the "critical view/open book" concept were offered to 125 attendees. Lectures on the rationale, surgical anatomy, techniques, and pitfalls of minimally invasive CME were followed by demonstration of predissected anatomical specimens. Tutored laparoscopic and robotic right hemicolectomies with CME were performed on body donors strictly adhering to the "critical view/open book" concept with subsequent quality assessment of resected specimens. A post-training questionnaire evaluated the "critical view/open book" concept related to its applicability, usefulness, efficacy, and adoption. RESULTS: The "critical view/open book" concept could be fully/mostly applied by 85.9% of the attendees during the surgical training courses. The most valuable insights gained were related to the retrocolic fascial system, vascular variations including the gastropancreaticocolic trunk, and the extent of mesocolic excision. Although most attendees had no previous experience with the "critical view/open book" concept, 83.3% of resected specimens fulfilled the highest quality standard (type 0, Benz classification). Intention to adopt the "critical view/open book" concept into clinical practice was stated by 80.9% of those attendees not previously familiar with this concept. CONCLUSION: The "critical view/open book" concept applied in surgical training courses proved to be an efficient teaching tool for minimally invasive CME and, thus, may be integrated into training curricula. Follow-up studies are needed to confirm its impact on long-term adoption and clinical outcome.