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Cianci S, Giovinazzo F, Campagna G, Ercoli A. Editorial: Challenges, techniques and pitfalls in surgery: How far can we push the boundaries? Front Oncol 2022; 12:1088759. [PMID: 36561524 PMCID: PMC9763988 DOI: 10.3389/fonc.2022.1088759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- S. Cianci
- Department of Human Pathology of Adult and Childhood “G. Barresi” Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy,*Correspondence: S. Cianci,
| | - F. Giovinazzo
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - G. Campagna
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy
| | - A. Ercoli
- Department of Human Pathology of Adult and Childhood “G. Barresi” Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
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The effect of laparoscopy courses in laparoscopy practice after urology resident training: A questionnaire-based observational study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.559559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Objectives: The aim of this study is to review the complications of laparoscopic urological procedures performed using a single surgeon during a 12-year period. Materials and Methods: From June 2004 to May 2017, a total of 411 abdominal urological procedures were performed using the author. They included 250 varicocele ligations, 94 nephrectomies (simple, partial, radical, and nephroureterectomy), 34 adrenalectomies, 22 renal cyst ablation, and 11 pelvic lymph node dissections. Operative and postoperative complications were reviewed and analyzed. The results were analyzed using Chi-squared tests for statistical analysis. Results: A total of 55 complications out of 411 procedures occurred in 26 patients with a total complication rate of 13.4%, 19 were major (4.6%), and 36 were minor (8.8%). Mortality occurred in two patients (0.5%). Conversion to open surgery was done in 5 patients (1.2%) to manage uncontrolled bleeding. Major intraoperative complications included vascular injuries (2.2%), injuries to the diaphragm (0.5%), bowel (0.7%), and pancreas (0.5%). Major postoperative complications included urine leak (0.2%) and pelvic lymphocele (0.2%). Minor intraoperative complications included bleeding during trocar access (4.4%) and subcutaneous emphysema (0.7%), whereas minor postoperative complications included atelectasis (1.2%) and ileus (2.2%). Conclusions: Even though the complications rate in this series was comparable to those of other studies in the literature, yet it remains higher than that of open surgery. The continuing advances in laparoscopic techniques will reduce the complication rate and will pave the way for laparoscopy to replace most currently practiced open surgical urological procedures.
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Affiliation(s)
- Khalid Al-Otaibi
- Department of Urology, College of Medicine, Imam Abdulrahaman Bin Faisl University, Dammam, Saudi Arabia
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[Ablative therapy in urology: Good practice and perspective]. Prog Urol 2017; 27:994-1014. [PMID: 28958771 DOI: 10.1016/j.purol.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To expose the main point of discussion from present ablative therapies' guidelines and propose global perspectives. MATERIALS AND METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com/) using different associations of keywords "ablative therapy" ; "prostate cancer"; "kidney cancer"; "guidelines"; "hybrid operating room". Publications obtained were selected based on methodology, language and relevance. RESULTS Present guidelines on ablative therapies in urology are, considering authors and organs, either particularly prudent (EAU guidelines for prostate and kidney) or relatively optimistic (CIRSE guidelines). This discrepancy is related to a low level of proof. So, a new approach is mandatory: more homogeneous in methodology, and especially more open to a new organization sparing economic efficiency. The objective will be to get multifunctional and multidisciplinaries platforms, in facts and in minds. It will induce, in the future, a deep reflection about training and boundaries' specialties. CONCLUSION Ablative therapies represent a crucial stake for urology and a clear example of medicosurgical evolution in future, based on new technologies (energy, robotic, imaging). A serious and deep reflection is necessary to prepare it and be deeply involved in.
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A Novel Bovine Model for Training Urological Surgeons in Laparoscopic Radical Nephrectomy. J Endourol 2011; 25:1377-83. [DOI: 10.1089/end.2011.0060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Mamut AE, Afshar K, Mickelson JJ, MacNeily AE. Surgical Case Volume in Canadian Urology Residency: A Comparison of Trends in Open and Minimally Invasive Surgical Experience. J Endourol 2011; 25:1063-7. [DOI: 10.1089/end.2010.0304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adiel E. Mamut
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer J. Mickelson
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew E. MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Autorino R, Haber GP, Stein RJ, Rane A, De Sio M, White MA, Yang B, de la Rosette JJ, Kaouk JH, Laguna MP. Laparoscopic Training in Urology: Critical Analysis of Current Evidence. J Endourol 2010; 24:1377-90. [DOI: 10.1089/end.2010.0005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Riccardo Autorino
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Urology Clinic, Second University of Naples, Naples, Italy
| | - Georges-Pascal Haber
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| | - Marco De Sio
- Urology Clinic, Second University of Naples, Naples, Italy
| | - Michael A. White
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Yang
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jean J. de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jihad H. Kaouk
- Center for Laparoscopy and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - M. Pilar Laguna
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Rabenalt R, Minh D, Dietel A, Bynens B, Papadoukakis S, McNeill A, Liatsikos E, Truss M, Stolzenburg JU. Laparoskopische Chirurgie in der Urologie. Urologe A 2006; 45:1155-6, 1158-60, 1162. [PMID: 16896759 DOI: 10.1007/s00120-006-1149-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Relatively long learning curves and, therefore, initially longer operating times compared to conventional procedures are still a matter of debate. Today, there are numerous possibilities for learning laparoscopic techniques and establishing one's own laparoscopic programs, including various pelvitrainers and virtual reality computer programs. One useful and realistic way involves "wet lab" training programs for ablative and reconstructive procedures using the pig model. Today, laparoscopic urological surgery includes procedures with low (e.g. laparoscopy for undescended testicles), intermediate (laparoscopic pyeloplasty) and high level (laparoscopic/endoscopic prostatectomy) complexity. Therefore, laparoscopy should be an integral part of training in urology. A defined number of possibly multi-institutional training centers with well structured educational programs are needed. The main goal should be the standardization of surgical procedures as well as educational training programs in order to shorten individual learning curves and generate common quality standards.
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Affiliation(s)
- R Rabenalt
- Klinik und Poliklinik für Urologie, Universitätsklinikum, Liebigstrasse 20, 04103, Leipzig
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Qazi HAR, Manikandan R, Philip J, Cornford PA, Parsons KF. Laparoscopic urology practice in the uk: current trends and future prospects. BJU Int 2006; 98:492-4. [PMID: 16925742 DOI: 10.1111/j.1464-410x.2006.06289.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hasan A R Qazi
- Department of Urology, The Royal Liverpool University Hospital, Liverpool, UK
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Matheus WE, Leitão VA, Thiel M, Palma PCR, Fernandes RC, Netto NR. Videolaparoscopic orchiectomy and nephrectomy: training model in rats. Urol Int 2006; 76:126-9. [PMID: 16493212 DOI: 10.1159/000090874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 08/30/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Videolaparoscopic surgery conducted on small animals has proved to be of great importance for the improvement of surgical skills. This is a report utilizing an experimental model for laparoscopic orchiectomy and nephrectomy in training courses for urologists. MATERIAL AND METHODS Of 350 American Wistar rats enrolled, 319 animals underwent laparoscopic orchiectomy and nephrectomy under intraperitoneal general anesthesia. Graspers, dissectors, and a 0-degree telescope were introduced into the peritoneal cavity by two trocars of 5 mm and one of 10 mm, respectively. RESULTS Of 350 rats enrolled, 15 (4.2%) died due to anesthetic complications and 16 (4.5%) due to cannibalism and stress during transport. A total of 319 rats were operated on, 178 underwent bilateral orchiectomy, two per model (356 operations), and in 141 animals one nephrectomy per model (141 operations) was performed. A total of 497 operations were performed involving 140 urologists. The animals were easy to handle providing adequate practice without the occurrence of any major intraperitoneal lesion and hemorrhage. CONCLUSION Nephrectomy and orchiectomy are feasible in rats, and this model can be utilized for training videolaparoscopic surgeries.
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Affiliation(s)
- Wagner Eduardo Matheus
- Division of Urology, Universidade Estadual de Campinas - UNICAMP, Campinas, São Paulo, Brazil
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Phillips J, Catto JWF, Lavin V, Doyle D, Smith DJ, Hastie KJ, Oakley NE. The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice. Postgrad Med J 2006; 81:599-603. [PMID: 16143692 PMCID: PMC1743358 DOI: 10.1136/pgmj.2004.030148] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There has been a dramatic increase in the interest and practice of laparoscopic urology, with nephrectomy having become the commonest laparoscopic urological procedure. Compared with open nephrectomy, it results in reduced morbidity and shorter convalescence times while maintaining oncological safety. However, while these results predominately stem from institutions with well developed laparoscopic programmes, little is known about the results in centres that have newly adopted this technique. The introduction of a laparoscopic urological service at the Royal Hallamshire Hospital provided an opportunity to study these factors. METHODS Since the appointment in October 2000 of a urological surgeon (N Oakley) to develop the laparoscopic service, there have been over 200 laparoscopic procedures including 121 nephrectomies performed at this centre. Full details were collected for each of these cases, and in addition, compared with retrospective data for 50 open nephrectomies performed during the same time period. RESULTS With increased operator experience the median operative duration, complication, transfusion, and conversion rates significantly improved. While a learning curve was evident, the overall operative complication (9%) and conversion rates (6%) were low, in addition to patient morbidity (16.5%) and mortality (0%) rates, showing that this learning curve had no deleterious effects upon patient care. The median hospital stay was four days, which reduced to three with experience and was significantly shorter than for open nephrectomy at this institution (p = 0.001). CONCLUSIONS The development of a successful laparoscopic programme can be achieved with a comparatively short learning curve and without detriment to the patient provided the necessary steps are observed.
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Affiliation(s)
- J Phillips
- Department of Urological Surgery, Royal Hallamshire Hospital, Sheffield, UK.
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Dauster B, Steinberg AP, Vassiliou MC, Bergman S, Stanbridge DD, Feldman LS, Fried GM. Validity of the MISTELS simulator for laparoscopy training in urology. J Endourol 2005; 19:541-5. [PMID: 15989441 DOI: 10.1089/end.2005.19.541] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) consists of a series of five laparoscopic exercises performed in an endotrainer box. MISTELS has been validated for use in both training and evaluation of general surgery residents in fundamental laparoscopic skills. The purpose of this study was to demonstrate the construct validity of MISTELS for urology residents. SUBJECTS AND METHODS Seventeen participants were evaluated during performance of the five MISTELS tasks (peg transfer, pattern cutting, ligating loop, and suturing with extracorporeal and intracorporeal knots) using the standardized scoring system, which rewards both speed and precision. Participants included 13 urology residents (PGY 1-5), 1 fellow, and 3 urologists experienced in laparoscopy. Results are expressed as median (range). The Mann-Whitney U-test was used to compare MISTELS scores for 9 novice (PGY 1-4) and 8 experienced urologists (PGY 5-attending). P < 0.05 was considered statistically significant. RESULTS The median MISTELS total normalized score for novices was 52.3 (range 15-68.9) compared with 71.7 (range 56.3-82.9) for experienced urologists (P = 0.007). Although the experienced group achieved higher scores in all five individual tasks, statistically significant differences were demonstrated for the peg transfer and intracorporeal suture tasks only. CONCLUSION These data provide evidence for construct validity of the MISTELS system for urology residents.
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Affiliation(s)
- Breno Dauster
- Department of Urology and Steinberg-Bernstein Centre for Minimally Invasive Surgery, Department of Surgery, McGill University, Montréal, Québec, Canada
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Laguna MP, Schreuders LC, Rassweiler JJ, Abbou CC, van Velthoven R, Janetschek G, Breda G, de la Rosette JJMCH. Development of Laparoscopic Surgery and Training Facilities in Europe: Results of a Survey of the European Society of Uro-Technology (ESUT). Eur Urol 2005; 47:346-51. [PMID: 15716199 DOI: 10.1016/j.eururo.2004.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 10/22/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The European Society of Uro-Technology (ESUT) conducted a survey in order to assess the application of laparoscopy and the facilitation of training programs within Europe. METHODS A total of 430 urologists and residents from European countries answered the ESUT survey during the XVIIIth Annual EAU Meeting in Madrid in 2003. The survey constituted of 11 questions of which nine with dual response (Y/N) options. Two questions, evaluating the importance of different training methods and different reasons not to be involved in laparoscopy, were assessed by means of a Likert type scale. RESULTS Laparoscopy was performed in 71% of urological departments. The majority (85%) of departments where no laparoscopy was performed, intended to establish it in the future. Two thirds of respondents believed laparoscopy would replace open surgery in the next 5 to 10 years. The access to training facilities was insufficient for 44%. Different methods of training were considered to be of equal importance. Among the reasons for not being involved in laparoscopic surgery a high variability was identified. CONCLUSIONS Laparoscopy is performed in the majority of urological departments in Europe. While there is a strong believe in the prominent role of laparoscopy in the mid-long future, access to training is still needed.
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Affiliation(s)
- M P Laguna
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Affiliation(s)
- Timothy Nedas
- Department of Urology, Guy's Hospital and GKT School of Medicine, London, UK
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Hollenbeck BK, Seifman BD, Wolf JS. Clinical Skills Acquisition for Hand-Assisted Laparoscopic Donor Nephrectomy. J Urol 2004; 171:35-9. [PMID: 14665838 DOI: 10.1097/01.ju.0000099680.27793.c5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The learning curve associated with laparoscopic surgery may be associated with higher patient risk, and in the setting of kidney donation such risk may be unacceptable. We characterize the learning curve for hand-assisted laparoscopic donor nephrectomy in the context of a urology training program, and establish a case volume threshold after which improvements in laparoscopic skill can be demonstrated. MATERIALS AND METHODS The study included 245 consecutive laparoscopic cases, including 111 donor nephrectomies, performed in 2 (1/2) years to characterize various measures of experience. Documentation of resident involvement in each case was made by a single surgeon and collected prospectively. Outcomes assessed included operative time, blood loss and intraoperative complications. RESULTS Of the 111 hand-assisted donor nephrectomies the resident was surgeon in 47%. Operative time proved a reliable and sensitive measure of surgeon experience. Increasing laparoscopic experience, as measured by several parameters, was associated with decreasing operative time (each p <0.02). Measurable improvements in laparoscopic skill were realized after participating in 13 (p = 0.007) or serving as surgeon in as few as 6 (p = 0.02) hand-assisted donor nephrectomies. Conversion (2%) and intraoperative complication rates (3%) were low. CONCLUSIONS Skills for hand-assisted laparoscopic donor nephrectomy can be safely taught in the context of a urology training program independent of resident training level. We documented measurable improvements in laparoscopic skill as gauged by operative time. Our findings provide a basis by which expectations can be set for laparoscopic skill acquisition in the context of a residency program and for the laparoscopically naïve surgeon.
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Affiliation(s)
- Daniel R Cottam
- Department of Surgery, The University of Pittsburgh, Pennsylvania, USA
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