Development of a surgical safety checklist for the performance of radical nephrectomy and tumor thrombectomy

Abstract

BackgroundThe surgical management of renal cell carcinoma with invasion of the renal vein or inferior vena cava is associated with significant rates of perioperative morbidity and mortality. In this report we propose a surgical checklist aimed at reducing adverse events associated with the resection of these tumors.MethodsThis review describes the development of an evidence- and experience-based surgical checklist aimed at improving the perioperative safety of patients undergoing radical nephrectomy and tumor thrombectomy.ResultsReducing the risk of complications during the surgical management of renal tumors with venous invasion begins with appropriate pre-operative imaging aimed at defining the cranial extent of the tumor thrombus, thus facilitating accurate preoperative planning. Other key elements of the checklist are aimed at ensuring clear and precise pre-, intra- and postoperative communication between members of the multidisciplinary-care team.ConclusionA standardized surgical checklist may help to increase the perioperative safety of patients undergoing radical nephrectomy and tumor thrombectomy. Future validation studies are required to determine the clinical feasibility and post-implementation safety profile of this new checklist.

Implementation of a novel living-donor kidney transplant preoperative checklist within the electronic medical record: a pilot study

“…Surgical checklists have been used successfully to improve safety. A number of studies attest to the effectiveness of checklists in accomplishing this [ 7 – 11 ]. To date, no prior publication describes the prevention of ‘never events’ in LDKT due to safety checklist implementation.…”

“…However, all are preventable with accurate pre-procedural knowledge. Many areas in healthcare and other industries utilize checklists to reduce rates of errors and catastrophic events [ 7 – 11 ]. This served as motivation for the development of the LDKT checklist.…”

First Resection of a Cavoatrial Renal Tumor Thrombus in a Pediatric Patient in Central America Based on a Multistage Surgical Safety Strategy Combining Liver Transplant Techniques and Cardiac Surgery

“…As previously reported, the evaluation and comprehensive management of patients with renal and level III/IV IVC TT by a multidisciplinary surgical team is a key component in achieving favorable oncological results [10-12]. The most important aspect emphasized herein is that despite our center having extensive experience in liver transplant surgery, the fundamental factor for the successful surgical resection of the current patient’s tumor in a developing country was the methodical application of an integral evaluation of the tumor extension together with a sequential safety planning for all possible surgical scenarios and stages.…”

“…Based on vast experiences with similar complex cases, a surgical safety checklist had been proposed as the standard in multidisciplinary evaluation and surgical management of renal tumors with IVC thrombosis in order to optimize the perioperative safety of such patients [10]. Similarly, a multistage surgical safety strategy was designed with the primary purpose of achieving urgent decompression of the IVC and RA from the obstructive effect of the massive TT.…”

“…One of the most important aspects of a successful intervention in this type of tumor is the precise evaluation of the extent of the TT [10]. Once extensive radiological and echocardiographic evaluation of the patient is completed, multiple multidisciplinary meetings were held within the 2 weeks prior to surgery, during which thorough surgical safety planning for liver transplant surgery, pediatric cardiac surgery, and pediatric cardiac anesthesia was performed as a fundamental pillar of safety according to available logistical resources [11].…”