Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

Objective:To correlate the utility of the Fundamentals of Laparoscopic Surgery(FLS)manual skills program with the Objective Structured Assessment of Technical Skills(OSATS)global rating scale in evaluating operative performance.Methods:The Asian Urological Surgery Training and Educational Group(AUSTEG)Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training.Delegates’basic laparoscopic skills were assessed using three different training models(peg transfer,precision cutting,and intra-corporeal suturing).They also performed live porcine laparoscopic surgery at the same workshop.Live surgery skills were assessed by blinded faculty using the OSATS rating scale.Results:From March 2016 to March 2019,a total of 81 certified urologists participated in the course,with a median of 5 years of post-residency experience.Although differences in task time did not reach statistical significance,those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks.However,they took longer to complete the precision cutting task than participants with less experience.Overall OSATS scores correlated weakly with all three FLS tasks(peg transfer time:r=0.331,r^(2)=0.110;precision cutting time:r=0.240,r^(2)=0.058;suturing with intracorporeal knot time:r=0.451,r^(2)=0.203).Conclusion:FLS task parameters did not correlate strongly with OSATS globing rating scale performance.Although FLS task models demonstrated strong validity,it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence,as evaluated by FLS and OSATS,respectively.

Transurethral resection of prostate for acute urinary retention is linked to shorter survival in younger men

It is largely unknown whether lower urinary tract symptoms(LUTS)or acute retention of urine(AROU)is linked to shorter life expectancy in men.We conducted a multicenter,retrospective database analysis of patients undergoing transurethral resection of prostate(TURP)to study their relationships.Multivariate Cox regression analysis and Kaplan-Meier analysis with stratification to age and indication of TURP were performed.We further performed an age-and sex-matched survival analysis with the general population using data from the Census and Statistics Department of the Hong Kong Special Administrative Region(Hong Kong,China).From January 2002 to December 2012,3496 patients undergoing TURP were included in our study,with 1764 patients in the LUTS group and 1732 patients in the AROU group.Old age,ischemic heart disease,cerebrovascular accident,and AROU were risk factors of mortality.Patients aged<70 years(adjusted hazard ratio[HR]:1.52,95%confidence interval[Cl]:1.11-2.09,P=0.010)and 70-80 years(adjusted HR:1.39,95%Cl:1.15-1.70,P-0.001)in the AROU group had worse survival than those in the LUTS group,but such difference was not demonstrated in patients aged>80 years.Compared to the general population,younger patients in the LUTS group appeared to have better survival(<70 years,P=0.091;70-80 years,P=0.011),but younger patients in the AROU group had worse survival(<70 years,P=0.021;70-80 years,P=0.003).For patients aged>80 years,survival was similar with the general population in both the LUTS and AROU groups.In conclusion,AROU at young age was associated with mortality,while early detection and management of LUTS may improve survival.