Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

Abstract

Introduction: Minimally invasive colonic anastomosis can be performed using intra-corporeal or extra-corporeal with laparoscopic or robotic assistance. In colorectal surgery, choosing the optimal approach is still controversial. Mainly, the debate involves balancing the potential benefits of intra-corporeal anastomosis (ICA) with increased technical difficultly with the more straightforward and widely accepted extra-corporeal anastomosis (ECA). Both techniques require different skill sets and this study aims to identify barriers that prevent adoption of ICA.

Methods: A 31-point questionnaire survey was distributed through the General Surgeons Australia (GSA) platform of active general surgeon in Australia. It was open for two months between July and August 2023. Statistical analysis was completed using descriptive analysis and logistic regression.

Results: 43 general surgeons completed the survey. ECA was the most performed and preferred surgical technique. It was identified that increased operative time is the biggest barrier to completing ICA followed by lack of training and no perceived benefit with ICA. Patient comorbidities did not result in choosing ICA over ECA, however, surgeons with less experience and volume in colorectal surgery were more likely complete ECA in operations with increased technical difficulty.

Conclusion: While ECA is the go-to technique for many Australian general surgeons, it's evident that they may be overlooking the benefits offered by ICA. Further training is required to improve operative times and confidence in the technique. Ongoing research, audits of existing techniques, and updated training will assist surgeons becoming acquainted with the latest evidence and to offer the best care to their patients.