{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Show Me The Evidence","title":"Experience Is Not Proficiency: Measuring what surgeons actually do | Show Me The Evidence E10","html":"","width":"100%","height":180,"duration":3786,"description":"In this episode, Professor Anthony G. Gallagher is joined by Dr Rui Farinha, a senior consultant urologist in Lisbon who has completed fellowships in Spain, Germany and Belgium in laparoscopic and robotic surgery, and who trained with Professor Alexandre Mottrie in Aalst and at Orsi Academy in Belgium. The two met at Orsi in 2019.\n\nThe conversation begins with a practical question. Robots are expensive, so what do they actually give the surgeon? Rui sets out the case carefully: tremor filtering and motion scaling for precision, wristed instruments for dexterity in tight anatomy such as the pelvis, magnified stereoscopic vision, better ergonomics over long procedures, and a digital platform capable of recording and analysing performance. Then he adds the caveat that frames the rest of the hour. None of these technical advantages automatically produces a better clinical outcome.\n\nFrom there the discussion turns to how surgeons are trained. Rui traces his own path through three eras: an apprenticeship model in open surgery that depended on which cases turned up and which consultant happened to be supervising, a laparoscopic era in which he discovered that open skills did not transfer and that basic skills belonged outside the operating theatre, and a robotic era that was structured from the start around defined objectives, simulation, proximate feedback and a demonstrated standard.\n\nThe heart of the episode is Rui's programme of research on robot-assisted partial nephrectomy (RAPN). He explains why he chose a technically demanding, high-risk procedure with clearly separable phases and direct consequences for the patient, and he sets out what the studies found. A complex operation can be deconstructed into observable phases, steps, errors and critical errors, with 100 per cent consensus from an international expert panel. Experienced surgeons made 69 per cent fewer total errors than novices. Within the experienced group, the low-error surgeons made 77 per cent fewer...","thumbnail_url":"https://img.transistorcdn.com/JPxx16guuIWtjNqUkS-VeCJVeP1R-gkQQ7xD4SsyqqM/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9lZGMy/MjkyM2UxYTkzZmM5/ZjVkMmI4MzAzOTM0/YTIzYi5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}