Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study

International audienceBackground: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery.Methods: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients.Results: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = − 0.92, p < 0.001) but was not correlated with the surgeon’s experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics.Conclusion: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management

Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database

Abstract Purpose To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. Materials and methods From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016–2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. Results The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. Conclusions Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of sta

Évaluation d’une reconnaissance automatisée des lithiases urinaires

Oral Communication. Abstract published in Progrès en urologie, 31(13):827, 2021International audienceObjectifs: L’évolution technologique en urologie réduit le nombre de fragments de calculs disponibles pour une analyse morpho-constitutionnelle. Une reconnaissance peropératoire faisant appel à l’intelligence artificielle (IA) pourrait permettre d’apporter les éléments d’analyse fondamentaux pour la prise en charge médicale de la maladie lithiasique. L’objectif de cette étude est d’évaluer le potentiel d’une méthode de reconnaissance automatisée des lithiases urinaires en endoscopie.Méthodes: À l’aide d’urétéroscopes, des images de surface et de section de 123 calculs urinaires humains, purs à plus de 85 %, ont été acquises (109 en ex vivo et 14 en in vivo). 6 classes de lithiases urinaires étaient représentées avec des calculs des groupes I (oxalate de calcium monohydraté, whewellite), II (oxalate de calcium dihydraté, weddellite), III (acide urique), IV avec les calculs de brushite et ceux de struvite, et V (cystine). La reconnaissance automatisée des calculs a été développée selon 2 approches : une méthode classique de classification et une méthode basée sur de l’apprentissage profond. Leur sensibilité et leur précision ont ensuite été évaluées.Résultats: Avec la méthode classique (basée sur des critères de textures et couleurs), la reconnaissance automatisée a respectivement une sensibilité et une valeur prédictive positive (VPP) de 91 % et 89 % pour la whewellite ; 99 % et 99 % pour la weddellite ; 88 % et 88 % pour l’acide urique ; 91 % et 90 % pour la struvite ; de 99 % et 99 % pour la cystine ; et 94 % et 99 % pour la brushite. Avec la méthode d’apprentissage profond (deep learning), la reconnaissance automatisée a respectivement une sensibilité et une spécificité de 99 % et 97 % pour la whewellite ; 98 % et 98 % pour la weddellite ; 97 % et 98 % pour l’acide urique ; 97 % et 96 % pour la struvite ; de 99 % et 99 % pour la cystine ; et 94 % et 98 % pour la brushite.Conclusion: Reconnaître un calcul en peropératoire représente un véritable enjeu. Mais peu d’urologues ont une expertise suffisante pour avoir un diagnostic comparable à l’analyse morpho-constitutionnelle. L’IA peut trouver une application dans ce domaine, avec des résultats prometteurs pour des calculs purs. D’autres études sur un panel plus important de calculs (purs et mixtes) sont nécessaires afin de développer ces méthodes

Comparison of surgical procedures for benign prostatic hyperplasia of medium-volume prostates: evaluation of the causes of rehospitalization from the French National Hospital Database (PMSI-MCO)

International audiencePurpose: In France, transurethral resection of the prostate (TURP) is still the most commonly used surgical treatment for medium sized benign prostatic hyperplasia (BPH), but the Holmium Laser Enucleation of the Prostate (HoLEP) and laser vaporization procedures are becoming more common. For these three surgical procedures, we evaluate the initial complications, the short term (3 months) and the 4–12-month postoperative complications necessitating re-hospitalization. Methods: From the French national hospital data base (PMSI-MCO), all hospitalizations for BPH treatment in 2018 were extracted. We document the complications during the initial hospitalization and any subsequent rehospitalizations during the one-year postoperative period. Results: In 2018, 67,220 patients were treated for BPH: 46,242 TURP, 13,509 HoLEP and 7469 laser vaporization. Age and anticoagulation medications were similar for men treated by the three procedures, but TURP patients were more often hypertensive. Infections and hemorrhagic complications were the most common complications at the initial hospitalization: 17%, 10%, 13% for infections and 15%, 8.1%, 11% for hemorrhagic complications respectively, and TURP performed worse than the other two procedures at the initial hospitalization. During the first three months and then the subsequent nine months, there were fewer complications than initially, with little difference between the three procedures, all differences being less than 1%. Conclusion: Laser vaporization techniques led to fewer complications. However, the PMSI-MCO only registers complications during hospitalizations. This study should be extended to non-hospitalized, more minor complications