Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery

Sotelo, René; Haese, Alexander; Machuca, Victor; Medina, Luis G.; Nuñez, Luciano; Santinelli, Flavio; Hernández, Andrés Felipe Valencia; Kural, Ali Rıza; Mottrie, Alexandre; Giedelman, Camilo; Mirandolino, Mariano; Palmer, Kenneth J.; Abaza, Ronney; Ghavamian, Reza; Shalhav, Arieh L.; Moinzadeh, Alireza; Patel, Vipul; Stifelman, Michael; Tüerk, Ingolf; Canes, David

doi:10.1016/j.eururo.2015.08.060

Cited by 41 publications

(26 citation statements)

References 75 publications

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“…Our results showed no significant differences in potential intrinsic and extrinsic risk factors for developing position‐related injuries such as sex, occurrence of comorbidities, high/low BMI and length of surgery, which have been reported in previous studies (Mills et al, ; Sotelo et al, ; Sukhu & Krupski, ). Statistical significance for differences in ASA classification was not tested in the present study due to that very few participants were classified into ASA 1 and ASA 4.…”

Section: Discussionsupporting

confidence: 73%

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Johansson

Vogelsang

2019

Journal of Clinical Nursing

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Aims and objectives To describe patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy in patients with bladder cancer. Background Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well‐known after prolonged surgery, especially in robot‐assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient‐related and operative risk factors. Methods A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study‐specific questionnaire 7–10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. Results Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7–10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. Conclusion A large proportion of the patients report postoperative extremity symptoms after robot‐assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow‐ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. Relevance to clinical practice This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow‐ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence‐based positioning guidelines in the operating theatre for optimal positioning.

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Section: Discussionsupporting

confidence: 73%

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Johansson

Vogelsang

2019

Journal of Clinical Nursing

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“…Surgical training is dependent on live patients for operative exposure and skill development, which creates a dilemma in finding an appropriate balance of patient safety and training efficacy . There is a great need for a safe, cost‐effective training tool for surgeons to develop their craft.…”

Section: Discussionmentioning

confidence: 99%

Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full‐immersion simulation platform for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP) utilizing three‐dimensional printing and hydrogel casting technology

et al. 2019

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ObjectivesTo incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Materials and MethodsAnatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into threedimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. Incorporating clinical metrics in a RARP model sparing radical prostatectomy and fruit for simple prostatectomy. Korean J Urol 2011; 52: 130-5 34 Clarebrough E, Christidis D, Lindner U, Fernandes K, Fleshner N, Lawrentschuk N. Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy. World J Urol 2019; 37: 799-804

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“…Non-technical skills training, error identification and crisis management have been key elements of aviation training for decades and there is evidence of increasing awareness and adoption of these important areas of robotic training [11,21]. However, it is recognised that often robotic training curriculums currently prioritise technical skills training and lack training in the area of non-technical skills [22].…”

Section: Training Curriculum Developmentmentioning

confidence: 99%

Training in robotic surgery, replicating the airline industry. How far have we come?

Collins

Wisz

2019

World J Urol

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Introduction As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important. We aim to compare current robotic training curricula with training in aviation, to evaluate current similarities and to provide insight into how healthcare can further learn from replicating initiatives in aviation training. Methods A systematic literature review of the current evidence was conducted online and relevant publications and information were identified. Evaluation and comparison between training in robotic surgery and the aviation industry was performed. Results There are significant similarities between modern robotic training curricula and pilot training. Both undergo basic training before proceeding to advanced training. Aviation training methods include classroom instruction, e-learning and practical training, in both the aircraft and flight simulation training devices. Both surgeon and pilot training include technical and procedural instruction as well as training in non-technical skills such as crisis management, decision making, leadership and communication. However, there is more regulation in aviation, with international standards for training curricula, simulation devices and instructors/trainers that are legally binding. Continuous learning with re-qualification with benchmarked high stakes tests are also mandatory throughout a pilot's and instructor's career. Conclusion Robotic surgeons and pilots roles have many fundamental similarities. Both work with expensive and complex technology requiring high levels of skills, within working environments with high physiological and psychological stress levels. Whilst many initiatives in aviation training have already been replicated in surgical training there remain considerable differences in regulation. Adopting established and proven aviation methods of assessment and regulation could help robotic surgical training become more efficient, more effective and ultimately safer.

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Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery

Cited by 41 publications

References 75 publications

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full‐immersion simulation platform for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP) utilizing three‐dimensional printing and hydrogel casting technology

Training in robotic surgery, replicating the airline industry. How far have we come?

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