European expert consensus on a structured approach to circular stapling anastomosis in minimally invasive left-sided colorectal resection.

Aim: The aim of this work is to develop and operationally define performance metrics that characterize a reference approach to circular stapling anastomosis during minimally invasive left-sided colorectal resection and to obtain face and content validity through a consensus meeting.

Method: Three expert colorectal surgeons with advanced experience with minimally invasive surgery, a senior behavioural scientist and a research fellow with experience in performance metrics development formed the Metrics Group. Technical support was provided by device engineers. Published guidelines, training materials, manufacturers' instructions for use and unedited videos of circular stapling anastomosis in minimally invasive left-sided colorectal resection were used to deconstruct the task into defined, observable performance units or metrics (i.e. procedural phases, steps, errors and critical errors). The performance metrics were then subjected to detailed review by 16 expert colorectal surgeons in a modified Delphi process.

Results: Performance metrics for circular stapling anastomosis during minimally invasive left-sided colorectal resection had three procedural phases with 32 steps, 40 errors and 38 critical errors. After the modified Delphi process the agreed performance metrics consisted of three procedural phases, 36 steps, 42 errors and 39 critical errors. A group of expert colorectal surgeons from Europe verified the face and content of these metrics. After discussion, all procedural phases received unanimous consensus by the Delphi panel.

Conclusion: Circular stapling anastomosis during the minimally invasive approach to left-sided colorectal resection can be broken down into procedural phases and steps, with errors and critical errors known as performance metrics. We consider the metrics essential for the development of structured training in using circular stapling anastomosis in the minimally invasive approach to left-sided colorectal resection.