Abstract
PurposeTo compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones.MethodsConsecutive 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.ResultsDuring 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.ConclusionLive surgical demonstrations do not seem to compromise patients’ safety and outcomes when performed by specialised endourologists.
Highlights
Live surgical demonstrations (LSDs) are a popular educational tool
The objective of this study is to evaluate possible differences in outcomes between endourological stone removal procedures performed during LSDs and during routine surgical practice (RSP)
Data were retrospectively collected from all consecutive endoscopic procedures performed for urinary stones in the academic center of the leading author from January 2011 through July 2015
Summary
Live surgical demonstrations (LSDs) are a popular educational tool. With the increased prevalence and popularity of LSDs, their educational value, professional and financial conflicts of interest and, above all, patients’ safety haveWorld J Urol (2017) 35:1745–1756 been questioned [1, 2]. Live surgical demonstrations (LSDs) are a popular educational tool. With the increased prevalence and popularity of LSDs, their educational value, professional and financial conflicts of interest and, above all, patients’ safety have. To secure patients’ safety, several surgical societies have published policy statements for the performance of LSDs [3]. The European Association of Urology (EAU) published a policy, which provides supportive information on how to organise and safely conduct LSDs. The paramount principle of this policy is that patients’ safety has top priority over all other considerations [1]. The literature about the safety of LSDs in the urological field is quite scarce. Most of the studies conducted are policy publications or surveys [1, 3,4,5,6] and the conclusions of these studies are not based on observations or treatment outcomes
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