The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course.

BACKGROUND: Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. OBJECTIVE: To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. DESIGN, SETTING, AND PARTICIPANTS: The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS AND LIMITATIONS: The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. CONCLUSIONS: The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. PATIENT SUMMARY: We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.

Simulation and training in Urology - in collaboration with ESU/ESUT / Simulación y entrenamiento en Urología - en colaboración con ESU/ESUT

Being a Surgeon today means taking on your shoulders countless responsibilities. It is definitely a high-stakes job but, even though the professionals do not go through the intense, focused and demanding training schedule as followed by the other equally risky fields, it doesn't yet require any practical training certification. Simulation was introduced in the aviation field in the early '30s with the "Link Trainer", designed to reproduce the most difficult flying case scenario: landing on an air-carrier. After almost a century, flight simulation is still becoming more sophisticated, while surgical training is slowly starting to fill the gap. The aim of a simulator is to produce an "imitation of the operation of a real-world process or system over time". This short but effective definition explains why simulators are utilised across different fields.There is no doubt that surgeons are continuously under-going a condition of stress, even in nonthreatening situations, while performing a procedure. This condition dds a relevant variable to surgery, meaning that mastering technical skills is not always equal to "safe surgery". This is why "non-technical skills" (NTS) training should be a part of any simulation based training opportunity and will probably start to be always more part of the Hands-on Training programs (AU)

Ser un cirujano significa llevar sobre los hombros incontables responsabilidades. Indudablemente, es un trabajo de altura, pero, aunque los profesionales no siguen una agenda de entrenamiento tan intensa, enfocada y exigente como la de otros campos con los mismos riesgos, no se requiere todavía ningún certificado de entrenamiento práctico. La simulación se introdujo en el campo de la aviación a principio de los años 30 con el "Link Trainer", diseñado para reproducir el escenario de vuelo más difícil: el aterrizaje de un avión carga. Después de casi un siglo, la simulación sigue haciéndose más sofisticada, mientras que el entrenamiento quirúrgico está andando el camino lentamente. El objetivo de un simulador es producir una "imitación de la operación de un proceso o sistema del mundo real con el tiempo". Esta definición corta y efectiva explica por qué se utilizan los simuladores en diferentes campos. No hay duda de que los cirujanos durante la realización de una operación están sometidos continuamente a una condición de estrés, incluso en las situaciones no amenazantes. Esta condición añade una variable relevante a la cirugía, lo que significa que dominar las habilidades técnicas no siempre equivale a hacer "cirugía segura". Es por esto por lo que el entrenamiento de las habilidades "no técnicas" debería ser parte de cualquier oportunidad de entrenamiento basado en simulación y empezará a ser siempre una parte más de los programas de entrenamiento práctico (AU)

Simulation and training in Urology - in collaboration with ESU/ESUT.

Being a Surgeon today means taking on your shoulders countless responsibilities. It is definitely a high-stakes job but, even though the professionals do not go through the intense, focused and demanding training schedule as followed by the other equally risky fields, it doesn't yet require any practical training certification. Simulation was introduced in the aviation field in the early '30s with the "Link Trainer", designed to reproduce the most difficult flying case scenario: landing on an air-carrier. After almost a century, flight simulation is still becoming more sophisticated, while surgical training is slowly starting to fill the gap. The aim of a simulator is to produce an "imitation of the operation of a real-world process or system over time". This short but effective definition explains why simulators are utilised across different fields. There is no doubt that surgeons are continuously undergoing a condition of stress, even in nonthreatening situations, while performing a procedure. This condition adds a relevant variable to surgery, meaning that mastering technical skills is not always equal to "safe surgery". This is why "non-technical skills" (NTS) training should be a part of any simulation based training opportunity and will probably start to be always more part of the Handson Training programs.