Matteo Soligo

Tailoring nomograms on patients and institutions: The utility of Fagan's two-step nomogram

Besides oncologic outcomes, functional outcomes (preservation of potency and early recovery of the pre-operative urinary continence) are the two main goals of radical prostatectomy. Tailoring the most appropriate but also the most conservative surgery in patients with low or intermediate risk prostate cancer is one of the hottest topic in urologic oncology nowdays. A number of nomograms, risk calculators and graphic tools have been developed to gather data from biopsy, blood samples and radiologic imaging and help clinicians to find the best balance between oncologic and functional goals. *Correspondence to: Tommaso Prayer Galetti, Department of Surgery, Oncology and Gastroenterology – Urology, University of Padova, Italy, Tel: +390498212720, Fax: +39.0498218758, E-mail: tommaso.prayer@aopd.veneto.it

Development of a Surgical Safety Training Program and Checklist for Conversion during Robotic Partial Nephrectomies

OBJECTIVEnTo evaluate the impact of standardized training and institutional checklists on improving teamwork during complications requiring open conversion from robotic-assisted partial nephrectomy (RAPN).nnnMATERIALS AND METHODSnParticipants 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.nnnRESULTSnGroup 1 showed a higher TC than group 2 (116.5 vs 86.5u2009seconds, Pu2009=u2009.0.53). 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 (R2u2009=u20090.75). TC shows a progressive decline for both groups as the number of simulations increases (group 1, R2u2009=u20090.7 and group 2, R2u2009=u20090.61), but it remains higher for group 1. Lack of task sequence and accidental falls or loss of sterility were higher in group 1.nnnCONCLUSIONnOC 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.