title: The Effectiveness of a Systematic Algorithm for the Management of Vascular Injuries during the Laparoscopic Surgery.
abstract: OBJECTIVE
  Currently, there is no standardized training protocol to teach surgeons how to deal with vascular injuries during laparoscopic procedures. The purpose of this study is to develop and evaluate the effectiveness of a standardized algorithm for managing vascular injury during laparoscopic nephrectomies.
  
  
  METHODS
  The performance of 6 surgeons was assessed during 10 laparoscopic nephrectomies in a porcine model. During the first and tenth operations, an injury was made in the renal vein without warning the surgeon. After the first procedure, the surgeons were instructed on how to proceed in dealing with the vascular injury, according to an algorithm developed by the designers of this study. The performance of each surgeon before and after learning the algorithm was assessed.
  
  
  RESULTS
  After learning the algorithm there was a decreased blood loss from 327 ± 403.11 ml to 37 ± 18.92 ml (p = 0.031) and decreased operative time from 43 ± 14.53 min to 27 ± 8.27 min (p = 0.015). There was also improvement in the time to start lesion repair from 147 ± 117.65 sec to 51 ± 39.09 sec (p = 0.025). There was a trend toward improvement in the reaction time to the injury (22 ± 21.55 sec vs. 14 ± 6.39, p = 0.188), the time required to control the bleeding (50 ± 94.2 sec vs. 14 ± 6.95 sec, p = 0.141), and the total time required to completely repair of the vascular injury (178 ± 170.4 sec vs. 119 ± 183.87 sec, p = 0.302).
  
  
  CONCLUSIONS
  A standardized algorithm may help to reduce the potential risks associated with laparoscopic surgery. Further studies will help to refine and determine the benefits of standardized protocols such as that developed in this study for the management of life-threatening laparoscopic complications.
authors.affiliation: Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil.
authors.forename: Carlo C
authors.initials: CC
authors.lastname: Passerotti
authors.affiliation: Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil; Center for Robotic Surgery, German Hospital Oswaldo Cruz, São Paulo, Brazil.
authors.forename: José A
authors.initials: JA
authors.lastname: Cruz
authors.affiliation: Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Reis
authors.affiliation: Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Marcelo T
authors.initials: MT
authors.lastname: Okano
authors.affiliation: Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Duarte
authors.affiliation: Urology Department, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Urology Department, Cardon Children Medical Center, Mesa, Ariz., USA.
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
keywords: Blood loss; Complication; Laparoscopy; Training