Technical challenges of lymphadenectomy in renal carcinoma performed with a 3D laparoscopic approach at a low pressure pneumoperitoneum due to associated pulmonary pathology - case report.

We report the case of a 63-year-old male patient presenting left renal cell carcinoma (75/70/60 mm) associated with retroperitoneal lymph node masses (peri hilar of 15 mm; lombo-aortic of 50/40/30 mm), known also with chronic obstructive pulmonary disease GOLD4, sleep apnea and asthma with oxygen-dependent chronic obstructive respiratory insufficiency, a BMI of 37 with grade III obesity. Surgical treatment was performed using a 3D transperitoneal laparoscopic approach. The surgery lasted 131 minutes, with 400 ml blood loss and grade 1 Clavien-Dindo post operative complications. An optimal pulmonary ventilation of the patient during surgery required a low intra-abdominal pressure (10 mmHg) which raised technical difficulties due to the lymph node mass dissection from the great vessels in a small operative field on an already obese patient with a voluminous renal tumor. The 3D transperitoneal laparoscopic approach was feasible within safe oncologic parameters.

Mental Fatigue Evaluation of Surgical Teams during a Regular Workday in a High-Volume Tertiary Healthcare Center.

INTRODUCTION: Considering the complex set of manual and psychological tasks a surgeon has to perform during the day, it is very important to assess the surgeon's fatigability, reaction time, attention, and memory. OBJECTIVE: Here, we wanted to determine the mental fatigue status of surgeons and how their abilities are affected through a regular workday. METHODS: We included 3 senior urologists and 6 urology residents. In a set period of time, we assessed their fatigue through self-assessed fatigue, Samn-Perelli score, and Karolinska sleepiness scale score. Further, reaction time, attention, and memory correlated with the number of the operations in the day, and total number of operations in that day were assessed. RESULTS: As the number of tasks increases, and as the surgeons advance to the end of the workday, they become more fatigued, reaction time ultimately increases, and attention and memory become slightly altered. CONCLUSIONS: Complications resulting from the fatigue of surgeons could be serious. Their performance status and skills decrease as they perform more tasks or advance through the day.