Day 1 of ESUT18: Simulation, Live Surgery and innovations in uro-technology

25 May 2018

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The first day of ESUT18 marked the beginning of a three-day meeting that aims to give its participants the best of new surgical technology in urology. The 6th Meeting of the EAU Section of Uro-Technology (ESUT) joined forces with the Italian Endourological Association (IEA) in Modena, Italy to accomplish this feat.

The meeting started with a welcome from Profs. Liatsikos (GR) and Bianchi (IT) on behalf of both societies, as well as Modena mayor Mr. Gian Carlo Muzzarelli. As the three (!) operating theatres made preparations for the simultaneous broadcast, Prof. Roberto Miano (IT) updated the audience on the SimBase project, in which the Italian Society of Urology takes part. SimBase uses simulators for training urological procedures in a standardized manner, yielding a variety of advantages over more conventional “see one, do one, teach one” principles.

Simulated training

Prof. Miano: “Medical errors are the third leading cause of death in the United States, following heart disease and cancer. These errors can be classified as judgmental errors (inadequate knowledge or so-called “never events” of preventable errors), technical errors (inadequate skill), expectation errors (inappropriate delegation of responsibility), system errors (staffing, protocol) or mechanical errors like equipment failure.”

Miano pointed out that technical errors are not easy to identify as they usually come together with sytem or judgmental errors. The trainability also differs per different procedures, leading to very different learning curves. “Training is key to preventing errors, and the patient cannot be the place for training.”

The aim of SimBase is to offer a standardized and centralized simulation-based training supplement to the local residency programme. It is focused on basic laparoscopy and basic upper tract endoscopy. The SIU has settled on renting 12 Pro-Lab v2 Trainers (appropriately enough, for a meeting in the carmaker’s hometown of Modena, described by Miano as “the Ferrari of trainers”), and lending them out in five month periods to resident training centres. This allows training at 24 venues in one year time. The lessons will be measured according to a performance improvement score and culminate in participation in the EAU’s E-BLUS exam at the annual SIU congress.

Live surgery

One of, or perhaps the single most important part of the ESUT18-IEA meeting is the live surgery. All stops were pulled out in Modena, offering audience not one or two live feeds, but a three-way simulcast. The audience was equipped with headsets to be able to follow the procedure of their choice. Each procedure was also separately moderated by a team of experts. As the live procedures followed their course and the patients were ready to leave the OR, interesting pre-recorded cases were also shown in each “channel”, presented live.

ESUT Chairman Prof. Liatsikos took part in the prone PCNL that was performed on Screen 1, and quickly found his way back to the auditorium to follow the rest of the scientific programme. “The procedure went well. I was assisting Dr. Davidoff, who was the main surgeon in this case. We wanted to show that a trainee could replicate this technique.”

Dr. Daniele Panarello from Genoa (IT) was one of the co-moderators of the procedures shown on Screen 1, and had closely followed the PCNL.

“Indeed it went well. It was a good procedure, rapidly performed, with not a lot of bleeding. At the beginning, there was some tension like every live surgery. This was due to little problems with the audio connection but they were soon resolved. The prone PCNL case was designed to offer proof that the procedure can be trained and replicated. It’s considered quite a difficult procedure, endourologically, mainly because of the access of the kidney.”

Dr. Panarello served as a “young provoker” in the moderator panel. “I was supposed to ask questions on behalf of the audience in order to clarify some points and to stimulate discussion.”

After the PCNL procedure, Screen 1 showed three consecutive pre-recorded case, two of which featured the use of the Cellvizio system. “The use of the Cellvizio system is just starting,” Panarello explained. “These were totally new procedures and particularly interesting for the audience.”