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Urology Residents Simulation Training Improves Clinical Outcomes in Laparoscopic Partial Nephrectomy

By 1 October 2021No Comments

Artur de Oliveira Paludo, Pedro Knijnik, Pietro Brum, Eduardo Cachoeira, Antonio Gorgen, Lucas Burttet, Renan Cabral, Stefano Puliatti, Tiago Rosito, Milton Berger, Brasil Silva Neto


Background: Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents’ laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil.

Methods: We accessed all patients undergoing LPN by senior’s urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named ‘LPN eras’ 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training.

Results: 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007).

Conclusions: Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.

Keywords: Laparoscopic; Partial nephrectomy; Residents; Simulation; Training.

Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Conflict of interest statement

Declaration of Competing Interest None.

Stefano Puliatti

Stefano Puliatti

Il Dr. Puliatti si è laureato in Medicina e chirurgia nel 2012 presso l’Università degli Studi di Modena ed ha poi conseguito il titolo di specialista in Urologia con il massimo dei voti presso lo stesso Ateneo. Da Luglio 2019 ricopre il ruolo di Assistant Professor in Urologia presso l'Università di Modena e Reggio Emilia. Da Luglio 2019 ricopre anche il ruolo di Deputy Medical Director of ORSI Academy, Melle, Belgio e svolge attività clinica e chirurgica presso OLV (Onze Lieve Vrouwziekenhuis) Hospital in Aalst, Belgio (direttore: Prof. Alex Mottrie). La sua formazione si è incentrata in particolare sulla Chirurgia robotica e oncologica delle vie urinarie, avendo come principali campi di applicazione anche tumori e malattie della prostata, tumori del rene e delle alte vie urinarie, disturbi minzionali, calcolosi delle vie urinarie. È inoltre autore e coautore di articoli scientifici e capitoli di libro in ambito urologico. Attualmente svolge attività in libera professione presso diverse strutture situate a Modena e Provincia.