Setting up the endoscopy room for benign prostatic hypertrophy treatment: Nursing expertise relevance

Abstract

In recent decades, nursing has been integrated into increasingly advanced and complex healthcare settings. One of the environments in which the level of preparation and expertise required of nurses is most adaptable is the operating room, where the variety of surgical approaches and the use of sometimes complex equipment at times requires a long learning curve. One of the specialties most affected in this regard is urology, with several techniques having emerged in recent years, particularly in the field of endoscopic treatment of benign prostatic hyperplasia (BPH). Understanding how the expertise of the surgical nurse may be influenced by the learning of new surgical procedures allows us to grasp how different the learning curve may differ between experienced and less experienced nurses in dealing with new surgical approaches. A total of 36 patients diagnosed with BPH and eligible for endoscopic treatments were enrolled (9 candidates for TURP, 9 for Holmium laser enucleation of the prostate (HoLEP), 9 for REZUM water vapour therapy, and 9 for UROLIFT). The nursing expertise was divided into three levels: novice (endoscopic room experience <6 months), competent (>1 year and 6 months of experience), and expert (experience >6 years). Objectively measurable data were collected regarding the instrumentation required to perform procedures, the setup time of the operating room and surgical devices, and the transition time between procedures in the same operating room. Surgical nurses were also asked to provide subjective commentary on the perceived difficulty in dealing with the four types of procedures. Regarding the learning curve of the surgical nurse, minimally invasive procedures were found to be more accessible to less experienced nurses. In particular, REZUM showed the most significant impact on reducing skill assimilation time. The impact of experience gained was notable for the endoscopic approaches of TURP and HoLEP: experienced surgical nurses were faster in acquiring new skills and setting up the materials needed for the surgical procedure. Considering nursing staff expertise and learning needs in the urologic endoscopy operating room is necessary and desirable because it allows easier and faster learning of new surgical approaches, especially in more complex techniques. Relying on experienced nursing staff is also desirable because it has an impact on overall operating time.