The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

[Survival prognostic factors valuation on a series of 202 patients with surgical treatment of renal cell carcinoma]. / Valoración de factores pronósticos de la supervivencia en una serie de 202 pacientes intervenidos por carcinoma de células renales.

OBJECTIVES: To describe renal cell carcinoma prognostic factors and set up the relationship with survival rates in this neoplasm. Likewise we show epidemiologic, clinical, diagnosis and therapeutic facts. MATERIAL AND METHOD: We review 202 patients underwent surgical treatment for renal cell carcinoma and the following features were recorded: gender, age and presenting symptoms, especially incidentally discovered tumors; tumor-related factors like TNM tumor stage, tumor grade and venous involvement: therapy-related recorded were surgical techniques and cytokine-based therapy. RESULTS: 60% of the patients showed organ-confined disease, 10% of patients with renal cell carcinoma presented with nodal positive disease and 7% with systemic metastases. 42% of patients presenting incidental tumor, with survival rates substantially better than that for symptomatic patients. 42% of patients with nodal positive disease presented systemic metastases at diagnosis, and 30% at surveillance. Systemic metastases presented a particularly poor prognosis for patients with renal cell carcinoma, with 12-months survival rates that 0%. Patients with cytokine-related therapy for metastatic disease presented 24-months survival rates that 20%. CONCLUSIONS: Renal cell carcinoma remains a major source of mortality, basically at advanced disease (nodal positive disease or systemic disease), without a clear improvement of survival rates despite the newer therapy modalities.

[The Burch technique in the surgical treatment of stress urinary incontinence in women. Assessment of results and analysis of failure causes]. / Técnica de Burch en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo femenina. Valoración de los resultados y análisis de las causas de los fracasos.

OBJECTIVE: To present our experience with the Burch procedure in the treatment of female urinary stress incontinence (USI) and the assessment of the causes of failure with this technique. MATERIAL AND METHODS: From January 1987 to june 1997 this technique was applied to 157 patients with USI. The mean age of these women was 54.2 years (30-76) and the mean follow-up was 50.24 months. Physical examination, urethral profile and the severity of the USI were not considered in the indication of the procedure. RESULTS: After three months, we had total continence or improvement in 80.7%. This rate decreased to 76% after one year. From the second year it was 70%, maintained to fifth year. Considering the severity of incontinence, in patients with mild-moderate grade, we obtained good outcomes after 5 years in 87%. If there was associated detrusor alterations, the rate decreased to 51.8%, and with a bad urethral profile, decreased to 42.4%. CONCLUSIONS: The Burch procedure is useful in the treatment of USI but requires a good selection of the patients.