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Development of a surgical safety training program and checklist for conversion during robotic partial nephrectomies

Urology Aug 31, 2017

Zattoni F, et al. – This study was carried out to assess the effect of standardized training and institutional checklists on improving teamwork during complications requiring open conversion (OC) from robotic–assisted partial nephrectomy (RAPN). According to the data, open conversion is a rare but potentially dramatic event in the setting of RAPN, and every robotic team should be prepared to manage intraoperative emergencies. It was considered that training protocols can effectively enhance teamwork and facilitate timely conversions to open surgery in the event of intraoperative emergencies during RAPN. Further studies are required to validate if such protocols may translate into an actual safety improvement in clinical settings.

Methods
  • In this research, participants to a surgical team safety training program were assigned randomly into two groups.
  • A sum of 20 emergencies were simulated; Group 1 performed simulations followed by a 4–hour theoretical training, Group 2 underwent 4–hour training first and then performed simulations.
  • Two independent physicians recorded and scored all simulations..
  • Between the two groups, time to conversion (TC) and procedural errors were analyzed and compared.
  • They conducted a correlation analysis between the number of previous conversion simulations, total errors number and TC for each group.

Results
  • Compare with group 2, group 1 displayed a higher TC (116.5 vs. 86.5 s, p=0.0.53).
  • It was showed that the numbers of errors declined in both groups as the number of simulation increased.
  • It was demonstrated that the two groups tend to converge towards 0 errors after 9 simulations nevertheless, the linear correlation was more pronounced in group 1 (R2=0.75).
  • TC displays a progressive decline for both groups as the number of simulations increases (group 1, R2=0.7 and group 2, R2=0.61), but it remains higher for group 1.
  • In group 1, lack of task sequence and accidental falls/loss of sterility were higher.
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