Department of Urology, Clinique Pasteur, Toulouse, France.
Department of Urology, Pitie Salpetrire Academic Hospital, Paris, France.
Eur Urol Focus. 2019 May;5(3):518-524. doi: 10.1016/j.euf.2018.01.001. Epub 2018 Jan 17.
Live surgery remains controversial. Although it may improve surgical training and accelerate the dissemination of technical steps of surgical procedures, controversy exists regarding patient safety in live surgery.
To compare the perioperative outcomes of "en bloc" green laser enucleation of the prostate (GreenLEP) performed in workshops during live case demonstration (LCD) and in standard conditions (SCs).
DESIGN, SETTING, AND PARTICIPANTS: Between June 2015 and January 2017, all consecutive patients who underwent GreenLEP for benign prostatic obstruction performed by a single surgeon were prospectively enrolled. Perioperative data and early postoperative complications according to Clavien-Dindo classification were collected. Workshop programmes started locally according to the European Association of Urology policy on live surgical events in June 2015 to enrol small groups of urologists in the GreenLEP technique.
Endoscopic enucleation of the prostate using a GreenLight fibre.
Outcomes were compared between the LCD and SC groups.
Of the 126 performed procedures, 37 were performed live during 17 LCDs with a median attendee number of 3. The patients' baseline characteristics were similar in both groups. Intraoperative parameters were comparable: total energy of 62 [53; 77] versus 56kJ [44; 69] (p=0.068), operative time of 61 [53; 71] versus 55min [45; 66] (p=0.1), and morcellating time of 3 [3; 5] versus 4min [2; 6] (p=0.82) in the LCD versus SC group. The catheterisation time (2d [1; 2]) and length of hospital stay (2d [2; 3]) were similar. The overall complication rate was comparable in the LCD (18.9%) and SC (24.7%) groups (p=0.64). Preoperative parameters significantly improved from baseline without any significant differences between the two groups. Limitations included a small number of attendees/workshop, and case selections were made by the surgeon himself.
GreenLEP was safe and provided satisfactory functional outcomes in both conditions. From this preliminary study, it seems that LCD did not jeopardise the surgeon's skill or technique. Similar studies are required to further assess patient safety and outcomes associated with live surgical events.
According to the surgeon expertise, endoscopic enucleation of the prostate performed during live case demonstration provided similar functional outcomes to that performed in standard condition and could therefore be considered a safe potential educational tool.
现场手术仍然存在争议。虽然现场手术可能会提高手术培训水平，并加速手术技术步骤的传播，但现场手术的患者安全性仍存在争议。
比较在现场手术演示（LCD）期间和标准条件（SCs）下进行“整块”绿激光前列腺切除术（GreenLEP）的围手术期结果。
设计、地点和参与者：2015 年 6 月至 2017 年 1 月期间，前瞻性纳入由一名外科医生连续进行的所有良性前列腺梗阻患者的 GreenLEP 手术。收集围手术期数据和根据 Clavien-Dindo 分类的早期术后并发症。根据欧洲泌尿外科学会关于现场手术事件的政策，现场手术计划于 2015 年 6 月在当地启动，目的是让小组成员学习 GreenLEP 技术。
使用 GreenLight 纤维进行内镜前列腺剜除术。
比较 LCD 组和 SC 组的结果。
在 126 例手术中，有 37 例在 17 次现场手术中进行，平均参会人数为 3 人。两组患者的基线特征相似。术中参数相似：总能量 62[53；77]与 56kJ[44；69]（p=0.068），手术时间 61[53；71]与 55min[45；66]（p=0.1），切碎时间 3[3；5]与 4min[2；6]（p=0.82），LCD 组和 SC 组。导管插入时间（2d[1；2]）和住院时间（2d[2；3]）相似。两组的总体并发症发生率相似（18.9%和 24.7%）（p=0.64）。术前参数均有明显改善，两组间无显著差异。局限性包括参会人数/学习班人数较少，以及病例选择由外科医生自行决定。
GreenLEP 在两种情况下均安全且提供满意的功能结果。从这项初步研究来看，现场手术似乎并未危及外科医生的技能。需要进一步开展研究以评估现场手术相关的患者安全性和结果。
根据外科医生的专业知识，在现场手术演示期间进行的内镜前列腺剜除术与在标准条件下进行的手术提供了相似的功能结果，因此可以被认为是一种安全的潜在教育工具。
