Zattoni Fabio, Morlacco Alessandro, Cattaneo Francesco, Soligo Matteo, Meggiato Luca, Modonutti Daniele, Valotto Claudio, Dal Moro Fabrizio, Zattoni Filiberto
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Italy; PhD Course in Clinical and Experimental Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy.
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Italy.
Urology. 2017 Nov;109:38-43. doi: 10.1016/j.urology.2017.06.057. Epub 2017 Aug 18.
To evaluate the impact of standardized training and institutional checklists on improving teamwork during complications requiring open conversion from robotic-assisted partial nephrectomy (RAPN).
Participants to a surgical team safety training program were randomly divided into 2 groups. A total 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. All simulations were recorded and scored by 2 independent physicians. Time to conversion (TC) and procedural errors were analyzed and compared between the 2 groups. A correlation analysis between the number of previous conversion simulations, total errors number, and TC was performed for each group.
Group 1 showed a higher TC than group 2 (116.5 vs 86.5 seconds, P = .0.53). As the number of simulation increased, the numbers of errors declined in both groups. The 2 groups tend to converge toward 0 errors after 9 simulations; however, the linear correlation was more pronounced in group 1 (R = 0.75). TC shows a progressive decline for both groups as the number of simulations increases (group 1, R = 0.7 and group 2, R = 0.61), but it remains higher for group 1. Lack of task sequence and accidental falls or loss of sterility were higher in group 1.
OC is a rare but potentially dramatic event in the setting of RAPN, and every robotic team should be prepared to manage intraoperative emergencies. Training protocols can effectively improve teamwork and facilitate timely conversions to open surgery in the event of intraoperative emergencies during RAPN. Further studies are needed to confirm if such protocols may translate into an actual safety improvement in clinical settings.
评估标准化培训和机构检查表对在机器人辅助部分肾切除术（RAPN）转为开放手术的并发症期间改善团队协作的影响。
参加手术团队安全培训项目的人员被随机分为两组。共模拟了20次紧急情况：第1组先进行模拟，然后进行4小时的理论培训；第2组先接受4小时培训，然后进行模拟。所有模拟均由2名独立的医生进行记录和评分。分析并比较两组的转换时间（TC）和操作失误情况。对每组先前转换模拟的次数、总失误次数和TC进行相关性分析。
第1组的TC高于第2组（116.5秒对86.5秒，P = 0.53）。随着模拟次数的增加，两组的失误次数均下降。两组在9次模拟后趋于零失误；然而，第1组的线性相关性更明显（R = 0.75）。随着模拟次数的增加，两组的TC均呈逐渐下降趋势（第1组，R = 0.7；第2组，R = 0.61），但第1组的TC仍然较高。第1组中任务顺序缺失以及意外跌倒或无菌状态丧失的情况更多。
在RAPN中，转为开放手术是一种罕见但可能很严重的事件，每个机器人手术团队都应做好处理术中紧急情况的准备。培训方案可以有效改善团队协作，并在RAPN术中紧急情况下促进及时转为开放手术。需要进一步研究以确认此类方案是否能在临床环境中转化为实际的安全性改善。
