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To present the positive impact of technique standardization on successful outcome, fluoroscopy, and total operating time (TOT) shortening in a prospective study.Six experienced endourologists participated. To assess whether the adaptation of standardized surgical steps improved their methodology with time, 253 patients were prospectively divided in three consecutive 1-month groups. Patients underwent stent placement and exchange and total operating and fluoroscopy times (FTs) were recorded. All surgeons were unaware of their mean recorded results until the end of the study. At the end of the third month, we evaluated if the suggested technique standardization established a decrease for both FT and TOT. Statistical significance was set to p 0.05.Total operating and FTs were significantly reduced with time between all groups of patients. For stent placement, TOT showed significant reduction between Groups A and C (p 0.001), while between other group comparisons did not reach significance. FT showed a significant reduction (p 0.001) in all group comparisons. For stent exchange, TOT reached significant improvement (p = 0.003) between Groups A and C, whereas between other groups was insignificant. FT improvement was significant between Groups A and C (p 0.001) and Groups B and C (p 0.001), but insignificant between Groups A and B.Even in experienced hands, the adaptation of technique standardization results in significant decrease of total operating and FTs and it is independent from feedback regarding their time performance.

Currently, the majority of operations in the urologic field can be performed laparoscopically. Even in experienced hands, some operations are considered of increased risk either because of increased surgical difficulty of the specific case or because the patient per se is at risk due to associated comorbidities. Scope of this review is to present the existent experience regarding difficult laparoscopic urologic cases, along with points of technique, the product of the experience collected by performing such difficult laparoscopic cases. Knowledge of anticipated difficulties allows both patients and their surgeons to be better prepared. Patients have their expectations from laparoscopy realistically set, whereas urologists, especially those new to laparoscopy, realize their abilities and properly set their indications to achieve the best for their patients.