Course Review

Doncaster third gastrointestinal anastomosis course

Authors: Judith Ritchie 

Publication date:  07 Dec 2012

Who is it for?

This excellent one day course is aimed at trainees in general surgery at core training year 1 to specialty training year 3 level. Trainees must have completed a basic surgical skills course and ideally should be doing a general surgical rotation so that the techniques covered in the course can be applied in clinical practice. The course is open to trainees from anywhere within the United Kingdom and is now becoming affiliated with the Association of Surgeons in Training.

Where is it held?

The course is run by the general surgery department of Doncaster Royal Infirmary and is led by consultant colorectal surgeon AB Harikrishnan, two consultant colleagues, and two registrars in general surgery. In future, the course will be held twice a year, with a maximum of 12 delegates on each course. Delegate numbers are limited to maintain a high trainer to trainee ratio. My course was oversubscribed fivefold.

Why did you do it?

Most trainees will have had an introduction to bowel anastomosis at a basic surgical skills course, along with numerous other technical skills. However, junior trainees tend to spend their time in theatre assisting rather than performing procedures. Surgical skills need focused practice, with guidance from experts who use the techniques on a daily basis. Furthermore, most anastomoses are stapled, which means trainees have little opportunity to learn and practise hand sewn anastomoses in theatre.

During my training I have spent time in theatre assisting with, and even tentatively performing parts of, stapled anastomoses. My objectives for this course were to consolidate what I already knew and to learn new approaches and techniques from tutors with expertise and experience in using them, in particular hand sewn anastomoses.

How was it structured?

Comfortably paced over seven hours, this hands-on course uses porcine models to cover techniques for hand sewn and stapled anastomoses: end to end hand sewn small bowel; side to side (functional end to end) small bowel; hand sewn and stapled side to side gastrojejunostomy; and end to end stapled colorectal anastomoses. Delegates work in pairs, taking turns to perform and assist at each procedure. The trainee to trainer ratio was 2:1; I have never had so much tutor attention and feedback on any one course.

In addition, the Covidien surgical stapling specialist took an active part in teaching, giving a talk, and showing the stapling devices in use, with valuable technical tips. The course minimised the number of sit-down lectures; after most of the talks there were demonstrations led by consultants, followed by hands-on practice in pairs in the well equipped wet laboratory, with group discussion of the indications for and complications of anastomotic surgery.

The course was well paced, giving sufficient time for each person to undertake focused practice with no sense of rush. Based on delegate feedback, the course organisers plan to extend the practical element of this course to include the technique of hand sewn colorectal anastomosis.

How much effort was required?

No formal preparatory work was required, but I would recommend that delegates ensure their basic knot tying and suturing skills are of a good standard before doing the course, to optimise time during the practical elements to develop new techniques specific to gastrointestinal anastomosis.

How much did it cost?

This course was free, with costs facilitated by an educational grant from Covidien UK. A deposit of £50 (cheque) was required to secure a place, but this was returned at the course.

Was it worth it?

Overall, the course was extremely well designed and was delivered smoothly and professionally, with excellent facilities and expert faculty. Attention had been paid to every detail—even seminal papers on anastomoses were included in the course pack along with a 2013 diary. The course met my expectations and objectives.

Given that training opportunities in theatre are becoming harder to come by, with operative simulation having an increasingly important role, wet laboratory based workshops are now an essential component of a surgical trainee’s portfolio. This course has given me a solid grounding in the theoretical and technical aspects of anastomoses and I now have the confidence to seek further opportunities to perform anastomoses in theatre. I therefore highly recommend this course to any trainee wanting a career in general surgery.

Top tips

  • Reserve a place early to avoid disappointment.

Further information

For further information contact the course facilitator, Jonathan RL Wild, registrar in general surgery at the Yorkshire and the Humber School of Surgery ( The next course is scheduled for March 2013.

Competing interests: None declared.

Judith Ritchie specialist trainee year 2, academic clinical fellow in surgical oncology Department of General Surgery, Northern General Hospital, Sheffield, UK

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