Hemorrhaging laparoscopic partial nephrectomy - feasibility of a novel simulation model

Area of Science:

• Surgical Education
• Medical Simulation
• Urology

Background:

• Intraoperative complications, such as uncontrolled bleeding during laparoscopic partial nephrectomy, present significant patient risks.
• Effective collaboration and communication among surgical teams are vital for managing such events.
• Non-technical skills are crucial for mitigating risks associated with surgical complications.

Purpose of the Study:

• To develop and evaluate a multidisciplinary surgical simulation scenario for intraoperative hemorrhage during laparoscopic partial nephrectomy.
• To facilitate the practice of crucial non-technical skills in a simulated high-stakes environment.
• To assess the value of the simulation in improving surgical residents' non-technical skills.

Main Methods:

• A novel, titratable, bleeding laparoscopic partial nephrectomy model was created for simulation.
• The scenario involved an intubated mannequin and a laparoscopic renal model, progressing from bleeding to cardiac arrest.
• Anesthesia and urology residents participated, with bleeding intensity adjusted based on resident performance.

Main Results:

• The porcine model successfully simulated laparoscopic partial nephrectomy bleeding for nine weeks, with adjustable bleeding levels.
• Residents found the scenario valuable for assessing and improving non-technical surgical skills.
• Participants indicated a need for more practice opportunities for non-technical skills in their residency curriculum.

Conclusions:

• Simulating intraoperative bleeding during partial nephrectomy with a crisis scenario offers a feasible and reproducible model.
• This immersive simulation effectively challenges residents' non-technical skills.
• The model can be used to enhance preparedness for managing surgical complications.