Top

Published in:

Open Access 01-11-2017 | Original Article

Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

Authors: Jaap D. Legemate, Stefano P. Zanetti, Joyce Baard, Guido M. Kamphuis, Emanuele Montanari, Olivier Traxer, Jean JMCH de la Rosette

Published in: World Journal of Urology | Issue 11/2017

Abstract

Purpose

To compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones.

Methods

Consecutive ureterorenoscopic (URS) and percutaneous (PNL) urinary stone procedures over a 5-year period were reviewed. Procedures were divided into LSDs and RSP. Differences between the groups were separately analysed for URS and PNL. Primary outcomes included intra- and post-operative complication rates and grades. Secondary outcomes were operation time, length of hospital stay, stone-free rate, and retreatment rate. Pearson’s Chi-square analysis, Mann–Whitney U test, and logistic and linear regression were used to compare outcomes between LSDs and RSP.

Results

During the study period, we performed 666 URSs and 182 PNLs, and 151 of these procedures were LSDs. Among URSs, the overall intra-operative complication rate was 3.2% for LSDs and 2.5% for RSP (p = 0.72) and the overall post-operative complication rate was 13.7% for LSDs and 8.8% for RSP (p = 0.13). Among PNLs, the overall intra-operative complication rate was 8.9% for LSDs and 5.6% for RSP (p = 0.52) and the overall post-operative complication rate was 28.6% for LSDs and 34.9% for RSP (p = 0.40). For both URSs and PNLs, no statistically significant differences in complication grade scores were observed between LSDs and RSP. Operation time was significantly longer for LSD-URS group, but there was no difference between the PNL groups. There were no significant differences in length of hospital stay and stone-free rate. The retreatment rate was higher in the LSD-URS group compared with RSP-URS group but similar between the PNL groups. Multiple logistic regression analyses, adjusting for confounders, revealed no association between LSD and more or less favourable outcomes as compared to RSP.

Conclusion

Live surgical demonstrations do not seem to compromise patients’ safety and outcomes when performed by specialised endourologists.

Available only for authorised users

Artibani W, Ficarra V, Challacombe BJ et al (2014) EAU policy on live surgery events. Eur Urol 66(1):87–97. doi:10.1016/j.eururo.2014.01.028 CrossRefPubMed

Kallmes DF, Cloft HJ, Molyneux A, Burger I, Brinjikji W, Murphy KP (2011) Live case demonstrations: patient safety, ethics, consent, and conflicts. Lancet 377(9776):1539–1541. doi:10.1016/S0140-6736(11)60357-7 CrossRefPubMed

Duty B, Okhunov Z, Friedlander J, Okeke Z, Smith A (2012) Live surgical demonstrations: an old, but increasingly controversial practice. URL. 79(5):1185e7–1185e11. doi:10.1016/j.urology.2011.12.037

Khan SAA, Chang RTM, Ahmed K et al (2014) Live surgical education: a perspective from the surgeons who perform it. BJU Int. 114(1):151–158. doi:10.1111/bju.12283 CrossRefPubMed

Surgical AU, Finch W, Urol F et al (2015) Would You Want to Be the Patient? “‘Live Surgical Broadcast’” or “‘As-Live Unedited Surgical Broadcast’”. J Endourol 29(7):821–829. doi:10.1089/end.2014.0580 CrossRef

Broadcasts AS, Wiseman O, James P, Clayman R (2016) Which Is Better? “‘Live’” Surgical Broadcasts vs “‘As-Live’” Surgical Broadcasts. J Endourol 30(9):1022–1028. doi:10.1089/end.2016.0165 CrossRef

Ito H, Kawahara T, Terao H et al (2013) Evaluation of preoperative measurement of stone surface area as a predictor of stone-free status after combined ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol 27(6):715–721. doi:10.1089/end.2012.0548 CrossRefPubMed

Tiselius H-G (2008) How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourol 22(2):249–255. doi:10.1089/end.2007.0225 CrossRefPubMed

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213. doi:10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentral

10.

De La Rosette JJMCH, Opondo D, Daels FPJ et al (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62(2):246–255. doi:10.1016/j.eururo.2012.03.055 CrossRefPubMed

11.

Perez Castro E, Osther PJS, Jinga V et al (2014) Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 66(1):102–109. doi:10.1016/j.eururo.2014.01.011 CrossRefPubMed

12.

Skolarikos A, Gross AJ, Krebs A et al (2015) Outcomes of flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. J Urol 194(1):137–143. doi:10.1016/j.juro.2015.01.112 CrossRefPubMed

13.

Baş O, Tuygun C, Dede O et al (2016) Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures—a single-center experience. World J Urol. doi:10.1007/s00345-016-1930-3 PubMed

14.

Hamamoto S, Yasui T, Okada A et al (2014) Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy. J Endourol 28(1):28–33. doi:10.1089/end.2013.0361 CrossRefPubMed

15.

Mullins JK, Borofsky MS, Allaf ME et al (2012) Live robotic surgery: are outcomes compromised? Urology. 80(3):602–606. doi:10.1016/j.urology.2012.03.050 CrossRefPubMed

16.

Liao Z, Li Z-S, Leung JW et al (2009) How safe and successful are live demonstrations of therapeutic ERCP? a large multicenter study. Am J Gastroenterol 104(1):47–52. doi:10.1038/ajg.2008.39 CrossRefPubMed

17.

Finch W, Masood J, Buchholz N, Turney BW, Smith D, Wiseman O (2015) Would You Want to Be the Patient? “Live Surgical Broadcast” or “As-Live Unedited Surgical Broadcast”. J Endourol 29(7):821–829. doi:10.1089/end.2014.0580 CrossRefPubMed

Title: Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?
Authors: Jaap D. Legemate
Stefano P. Zanetti
Joyce Baard
Guido M. Kamphuis
Emanuele Montanari
Olivier Traxer
Jean JMCH de la Rosette
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 11/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2050-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2017

A prospective randomized comparison of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones

The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis

Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A

Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes

Dose dense MVAC prior to radical cystectomy: a real-world experience

Laparoscopic vesico-ureteral reimplantation with Lich–Gregoir approach in children: medium term results of 159 renal units in 117 children