| OBSERVATIONAL TRAINING VISIT TO PROFESSOR STOLZENBURG IN LEIPZIG - CONSULTANT WITH WITH THREE THEATRE NURSES. Dr Pradip Javle Leighton Hospital, Crewe |
I have offered Laparoscopic radical prostatectomies for localised prostate cancer for over 18 months. Laparoscopic technique offers advantages over the open technique with reduced blood loss, improved potency preservation and early recovery. A voice activated robotic arm for camera assistance has helped the progress of my team and the early learning curve. However, we were still not able to carry out the procedure and offer outcomes comparable to centres of excellence.
Therefore, with my team (of regular theatre staff), I explored the possibility of visiting centres of excellence to improve technique and theatre ergonomics with the aim being:
- reduction in operating time by improving theatre ergonomics
- better preservation of the neurovascular bundles and therefore potency
- Improved anastomosis offering early catheter removal
Prostate Cancer Campaign UK, working through John Anderson, kindly agreed to support our visit but our own Trust was unable to support us with this venture.
We travelled to Leipzig in the first leg of our tour on the 20th November 2005 and attended Professor Stolzenburg′s operating sessions every day from 8.00am to 5.00pm. He and his colleagues were very welcoming and helped us to achieve our goals in every way. We learnt:
- Ways in efficient use of operating time and personnel. The entire process from transfer of patient from the ward, anaesthesia, recovery and transfer back to the ward were carried out by a team of 5 staff members. We were used to using over twice as many! We observed a number of theatre manouveres to improve our theatre time usage.
- Prof Stolzenburg demonstrated his new method at preserving the neurovascular bundles over 4 days of our stay.
- The importance of a good assistant and scrub nurse was made evident by their demonstration that the assistant conducts a substantial part of the operation.
- Their novel method of anastomosis appears to be superior.
- Observing their technique of anaesthesia will help me convince my anaesthetist that there is no need for a number of special arterial, venous and epidural lines for these patients; this will save time and money for the NHS.
- A number of manoeuvres to improve theatre "turn-around" time and thereby make the best possible use of expensive theatre time.
- A completely different way of aligning the robotic arm to prevent it coming in the way of the primary surgeon.
We returned home on the evening of the 24th. Our stay was at a modest hotel within walking distance of the hospital, we would breakfast at the hotel and our only significant expenditure was an evening meal. Therefore we have managed this trip (for three members) for under £1700. We hope to be as prudent in our expenditure for the second leg of this venture in April 2006.
We have implemented a number of these changes in our theatre. Whilst it is early days yet to comment on the benefits, it has certainly helped me achieve the following in the last 10 cases since return from Leipzig: improved and quicker port placement, no surgical emphysema and a marked reduction in operating time. I am certain that with more experience, my team will help my patients achieve significantly better outcomes. The second leg of our learning experience to Creitiel is planned for April 2006.
Research report dated 01 May 2006
Project 2004/12