A National (UK) Multi-Centre Review of Current Practice, led by the North West Research Collaborative
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Email: LEGS.Study@gmail.com
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Objectives
To LEGS Study aims to:
- Evaluate current UK practice in the use of laparoscopy in emergency surgery
- Determining the factors affecting the variable practice of emergency general surgical laparoscopy.
Background
There are clear consensus guidelines and recommendations outlining conditions for which laparoscopic approaches may be useful, safe and feasible in the management of the acute abdomen.1,2 European surveys have found the uptake of laparoscopy in emergency general surgery to be variable.3 The National Emergency Laparotomy Audit (NELA) has shown that use of laparoscopy in emergency surgery in the UK is minimal with no increase in temporal uptake. In Year 1 of data collection, 13% of emergency cases submitted started laparoscopically and 7% were completed using this approach. In the second year, this marginally improved to 14% and 8% respectively.4 A number of reasons have been suggested to explain this: a steep learning curve, uncertainty about the procedures effectiveness, long operative times and lack of tactile feedback.5-8
It is uncertain whether all emergency cases performed laparoscopically are being recorded in the NELA database, and the factors influencing the use of laparoscopy in emergency general surgery remain unclear.
Methods
This is a national prospective cross-sectional questionnaire survey of currently practicing general surgical consultants. The questionnaire includes basic demographic information, number of operations performed and laparoscopic experience. Further questions use a likert scale to determine the likelihood of using laparoscopy for different emergency presentations and are supplemented by scenario based questions. Following an initial pilot sample, the questionnaire will be distributed nationally via research collaborative networks. The questionnaire responses will be initially completed in paper format, then uploaded to the REDCap database by a designated surgical trainee at each participating site.
Recruitment:
We welcome all expressions of interest from anyone interested in participating in the LEGS questionnaire survey. Please contact us by Email at: LEGS.Study@gmail.com or use the contact form at the bottom of this page.
Presentations:
North West Research Collaborative Meeting (Scheduled for November 2017)
Contributors:
Chief Investigator
Mr Abhi Sharma
Consultant General and Colorectal Surgeon, Manchester University NHS Foundation Trust
Honorary Senior Lecturer, University of Manchester
Northwest Research Collaborative LEGS Steering Committee:
Mr Nick Heywood, Specialty Trainee, North West Deanery (Steering Committee Chair)
Miss Kat Parmar, Specialty Trainee, North West Deanery
Mr Martyn Stott, Specialty Trainee, North West Deanery
Mr Jieqi Lim, Core Surgical Trainee, North West Deanery
Dr Dan Doherty, Core Surgical Trainee, North West Deanery
Dr Peter Sodde, Foundation Doctor, Salford Royal NHS Trust
Other Contributors:
The LEGS Study is being supported by the North West Surgical Trials Centre
References:
1) Agresta, F., Ansaloni, L., Baiocchi, G.L., Bergamini, C., Campanile, F.C., Carlucci, M., Cocorullo, G., Corradi, A., Franzato, B., Lupo, M. and Mandalà, V., 2012. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surgical endoscopy, 26(8), pp.2134-2164.
2) Sartelli, M., Viale, P., Catena, F., Ansaloni, L., Moore, E., Malangoni, M., Moore, F.A., Velmahos, G., Coimbra, R., Ivatury, R. and Peitzman, A., 2013. 2013 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery, 8(1), p.3.
3) Agresta, F., Campanile, F.C., Podda, M., Cillara, N., Pernazza, G., Giaccaglia, V., Ciccoritti, L., Ioia, G., Mandalà, S., La Barbera, C. and Birindelli, A., 2016. Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years. Surgical Endoscopy, pp.1-11.
4) NELA Project Team, Second Patient Report of the National Emergency Laparotomy Audit, RCoA, London, 2016. Available online at: http://www.nela.org.uk/reports
5) Agresta, F., De Simone, P. and Bedin, N., 2004. The laparoscopic approach in abdominal emergencies: a single center 10-year experience. Journal-Society Of Laparoendoscopic Surgeons, 8(1), pp.25-30.
6) Agresta, F., De Simone, P., Ciardo, L.F. and Bedin, N., 2004. Direct trocar insertion vs Veress needle in nonobese patients undergoing laparoscopic procedures: a randomized prospective single-center study. Surgical endoscopy, 18(12), pp.1778-1781.
7) Alvarez, C. and Voitk, A.J., 2000. The road to ambulatory laparoscopic management of perforated appendicitis. The American journal of surgery, 179(1), pp.63-66.
8) Bailey, I.S., Rhodes, M., O’rourke, N., Nathanson, L. and Fielding, G., 1998. Laparoscopic management of acute small bowel obstruction. British journal of surgery, 85(1), pp.84-87.
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