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To describe the safety and feasibility of urological transfusion-free surgeries in Jehovah's Witness patients. Methods: An institutional review board-approved, retrospective review of Jehovah's Witness patients who underwent urological transfusion-free surgeries between 2003 and 2019 was carried out. Surgeries were stratified into low, intermediate and high risk based on complexity, invasiveness and bleeding potential. Patient demographics, perioperative data and clinical outcomes are reported. Results: A total of 161 Jehovah's Witness patients (median age 63.4 years) underwent 171 transfusion-free surgeries, including 57 (33.3%) in low-, 82 (47.9%) in intermediateand 32 (18.8%) in high-risk categories. The mean estimated blood loss increased with risk category at 48 mL (range 10-50 mL), 150 mL (range 50-200 mL) and 388 mL (range 137-500 mL), respectively (P < 0.001). Implementing blood augmentation and conservation techniques increased with each risk category (3.5% vs 29% vs 69%, respectively; P < 0.001). Average length of stay increased concordantly at 1.6 days (range 0-12 days), 2.9 days (range 1-13 days) and 5.6 days (range 2-12 days), respectively (P ≤ 0.001). However, there was no increase in complication rates and readmission rates attributed to bleeding among the risk categories at 30 days (P = 0.9 and 0.4, respectively) and 90 days (P = 0.7 and 0.7, respectively). Conclusions: Transfusion free urological surgery can be safely carried out on Jehovah's Witness patients using contemporary perioperative optimization. Additionally, these techniques can be expanded for use in the general patient population to avoid short-and long-term consequences of perioperative blood transfusion.

the surgeon's view, the endoscopic view, and a 360-degree view of the OR. Following each case, the staff surgeon assessed resident performance using the 11-item entrustment-based Ottawa Surgical Competency Operating Room Score Evaluation (O-SCORE), and evaluated his or her own cognitive load during the case using the Surgical Task Load Index (SURG-TLX). Two independent staff urologists reviewed each video using the same assessment tools. Raters' results were compared those of the case surgeons. RESULTS: Over 15 cases, 630 minutes of video was collected of 7 residents and 5 staff surgeons. Six cases were completed by junior residents and 9 by senior residents. The interrater reliability between video assessors was highly correlated (k[0.82). Comparisons between intraoperative assessment, video-based assessment, and mean O-SCOREs were also highly correlated (r[0.7). Evaluation of O-SCORE domains for intraoperative performance showed a slight decrease in correlation between the intraoperative assessment and video-based assessment (r[0.68). All assessors (video and staff surgeons) expressed low cognitive load, with mean SURG-TLX scores of 5 (out of a possible 100) (SD AE1.8). Video-based assessors frequently rewound the video during critical steps of each case to evaluate resident performance.CONCLUSIONS: We showed that video-based assessment of resident performance during ureteroscopy and laser lithotripsy using the O-SCORE is useful and feasible, with high interrater reliability among the case surgeon and independent video reviewers. Use of the SURG-TLX provided new insight into the cognitive load of both case surgeons and video assessors. Additional research with other types of surgical cases is required to further explore the use of videobased assessment in the OR.