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Basile G, Pecoraro A, Gallioli A, Territo A, Berquin C, Robalino J, Bravo A, Huguet J, Rodriguez-Faba Ó, Gavrilov P, Facundo C, Guirado L, Gaya JM, Palou J, Breda A. Robotic kidney transplantation. Nat Rev Urol 2024; 21:521-533. [PMID: 38480898 DOI: 10.1038/s41585-024-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 09/06/2024]
Abstract
Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patients with obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessio Pecoraro
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Camille Berquin
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre, Ghent, Belgium
| | - Jorge Robalino
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Bravo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Óscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Pavel Gavrilov
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Facundo
- Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
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Larcher A, Belladelli F, Cei F, Re C, Rowe I, Montorsi F, Capitanio U, Salonia A. Centralization of care for rare genetic syndromes associated with cancer: improving outcomes and advancing research on VHL disease. Nat Rev Urol 2024; 21:565-571. [PMID: 38719914 DOI: 10.1038/s41585-024-00874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 09/06/2024]
Abstract
Von Hippel-Lindau (VHL) disease is a rare genetic syndrome caused by a germline pathogenic variant in one VHL allele. Any somatic event disrupting the other allele induces VHL protein (pVHL) loss of function, ultimately leading to patients developing multiple tumours in multiple organs at multiple timepoints, and reducing life expectancy. Treatment of this complex, rare disease is often fragmented, as patients visit specialist clinicians in isolation at different medical centres. Consequently, patients can receive sub-optimal treatment that results in decreased quality of life and a poor experience of health care systems. In 2021, we established a comprehensive clinical centre at San Raffaele Hospital, Milan, devoted to VHL disease. The centre provides a structured programme for the diagnosis, surveillance and treatment of patients alongside research into VHL disease and involves a multidisciplinary team of dedicated physicians. This programme demonstrates the benefits of care centralization, including concentration of knowledge and services, synergy and multidisciplinary management, improved networking and patient resources, reducing health care costs, and fostering research and innovation. VHL disease provides an ideal model to assess the advantages of centralizing care for rare disease and represents an unparalleled opportunity to broaden our understanding of cancer biology in general.
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Affiliation(s)
- Alessandro Larcher
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Cei
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Re
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Isaline Rowe
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
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Cei F, Larcher A, Rosiello G, Basile G, Musso G, Re C, Fallara G, Belladelli F, Brembilla G, Guazzarotti G, De Cobelli F, Marandino L, Necchi A, Briganti A, Salonia A, Bertini R, Montorsi F, Capitanio U. Preoperative risk calculator for the probability of completing nephron sparing for kidney cancer. Urol Oncol 2024; 42:247.e21-247.e27. [PMID: 38644109 DOI: 10.1016/j.urolonc.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE In absence of predictive models, preoperative estimation of the probability of completing partial (PN) relative to radical nephrectomy (RN) is invariably inaccurate and subjective. We aimed to develop an evidence-based model to assess objectively the probability of PN completion based on patients' characteristics, tumor's complexity, urologist expertise and surgical approach. DESIGN, SETTING AND PARTICIPANTS 675 patients treated with PN or RN for cT1-2 cN0 cM0 renal mass by seven surgeons at one single experienced centre from 2000 to 2019. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSES The outcome of the study was PN completion. We used a multivariable logistic regression (MVA) model to investigate predictors of PN completion. We used SPARE score to assess tumor complexity. We used a bootstrap validation to compute the model's predictive accuracy. We investigated the relationship between the outcomes and specific predictors of interest such as tumor's complexity, approach and experience. RESULTS Of 675 patients, 360 (53%) were treated with PN vs. 315 (47%) with RN. Smaller tumors [Odds ratio (OR): 0.52, 95%CI 0.44-0.61; P < 0.001], lower SPARE score (OR: 0.67, 95%CI 0.47-0.94; P = 0.02), more experienced surgeons (OR: 1.01, 95%CI 1.00-1.02; P < 0.01), robotic (OR: 10; P < 0.001) and open (OR: 36; P < 0.001) compared to laparoscopic approach resulted associated with higher probability of PN completion. Predictive accuracy of the model was 0.94 (95% CI 0.93-0.95). CONCLUSIONS The probability of PN completion can be preoperatively assessed, with optimal accuracy relaying on routinely available clinical information. The proposed model might be useful in preoperative decision-making, patient consensus, or during preoperative counselling. PATIENT SUMMARY In patients with a renal mass the probability of completing a partial nephrectomy varies considerably and without a predictive model is invariably inaccurate and subjective. In this study we build-up a risk calculator based on easily available preoperative variables that can predict with optimal accuracy the probability of not removing the entire kidney.
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Affiliation(s)
- Francesco Cei
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Giuseppe Rosiello
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Basile
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giacomo Musso
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Re
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgio Brembilla
- University Vita-Salute San Raffaele, Milan, Italy; Department of Radiology, IRCCS San Raffaele, Milan, Italy
| | | | - Francesco De Cobelli
- University Vita-Salute San Raffaele, Milan, Italy; Department of Radiology, IRCCS San Raffaele, Milan, Italy
| | - Laura Marandino
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Necchi
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Roberto Bertini
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
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Basile G, Gallioli A, Diana P, Gallagher A, Larcher A, Graefen M, Harke N, Traxer O, Tilki D, Van Der Poel H, Emiliani E, Angerri O, Wagner C, Montorsi F, Wiklund P, Somani B, Buffi N, Mottrie A, Liatsikos E, Breda A. Current Standards for Training in Robot-assisted Surgery and Endourology: A Systematic Review. Eur Urol 2024; 86:130-145. [PMID: 38644144 DOI: 10.1016/j.eururo.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Different training programs have been developed to improve trainee outcomes in urology. However, evidence on the optimal training methodology is sparse. Our aim was to provide a comprehensive description of the training programs available for urological robotic surgery and endourology, assess their validity, and highlight the fundamental elements of future training pathways. METHODS We systematically reviewed the literature using PubMed/Medline, Embase, and Web of Science databases. The validity of each training model was assessed. The methodological quality of studies on metrics and curricula was graded using the MERSQI scale. The level of evidence (LoE) and level of recommendation for surgical curricula were awarded using the educational Oxford Centre for Evidence-Based Medicine classification. KEY FINDINGS AND LIMITATIONS A total of 75 studies were identified. Many simulators have been developed to aid trainees in mastering skills required for both robotic and endourology procedures, but only four demonstrated predictive validity. For assessment of trainee proficiency, we identified 18 in robotics training and six in endourology training; however, the majority are Likert-type scales. Although proficiency-based progression (PBP) curricula demonstrated superior outcomes to traditional training in preclinical settings, only four of six (67%) in robotics and three of nine (33%) in endourology are PBP-based. Among these, the Fundamentals of Robotic Surgery and the SIMULATE curricula have the highest LoE (level 1b). The lack of a quantitative synthesis is the main limitation of our study. CONCLUSIONS AND CLINICAL IMPLICATIONS Training curricula that integrate simulators and PBP methodology have been introduced to standardize trainee outcomes in robotics and endourology. However, evidence regarding their educational impact remains restricted to preclinical studies. Efforts should be made to expand these training programs to different surgical procedures and assess their clinical impact.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Anthony Gallagher
- Faculty of Medicine, KU Leuven, Leuven, Belgium; Faculty of Health and Life Sciences, Ulster University, Coleraine, UK; ORSI Academy, Melle, Belgium
| | | | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Olivier Traxer
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Henk Van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | | | - Peter Wiklund
- Icahn School of Medicine, Mount Sinai Health System New York City, NY, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Nicolò Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alex Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, OLV Hospital, Aalst, Belgium
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain
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Sickinghe A, Nobbenhuis M, Nelissen E, Heath O, Ind T. Proficiency-based progression training in robot-assisted laparoscopy for endometrial cancer: peri-operative and survival outcomes from an observational cohort study. Front Med (Lausanne) 2024; 11:1370836. [PMID: 38903811 PMCID: PMC11188306 DOI: 10.3389/fmed.2024.1370836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Over the last decade there has been a transition from traditional laparoscopy to robotic surgery for the treatment of endometrial cancer. A number of gynecological oncology surgical fellowship programmes have adopted robot-assisted laparoscopy, but the effect of training on complications and survival has not been evaluated. Our aim was to assess the impact of a proficiency-based progression training curriculum in robot-assisted laparoscopy on peri-operative and survival outcomes for endometrial cancer. Methods This is an observational cohort study performed in a tertiary referral and subspecialty training center. Women with primary endometrial cancer treated with robot-assisted laparoscopic surgery between 2015 and 2022 were included. Surgery would normally include a hysterectomy and salpingo-oophorectomy with some form of pelvic lymph node dissection (sentinel lymph nodes or lymphadenectomy). Training was provided according to a training curriculum which involves step-wise progression of the trainee based on proficiency to perform a certain surgical technique. Training cases were identified pre-operatively by consultant surgeons based on clinical factors. Case complexity matched the experience of the trainee. Main outcome measures were intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theater rates and 5-year disease-free and disease-specific survival for training versus non-training cases. Mann-Witney U, Pearson's chi-squared, multivariable regression, Kaplan-Meier and Cox proportional hazard analyses were performed to assess the effect of proficiency-based progression training on peri-operative and survival outcomes. Results Training cases had a lower BMI than non-training cases (30 versus 32 kg/m2, p = 0.013), but were comparable in age, performance status and comorbidities. Training had no influence on intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theater rates and median 5-year disease-free and disease-specific survival. Operating time was longer in training cases (161 versus 137 min, p = < 0.001). The range of estimated blood loss was smaller in training cases. Conversion rates, critical care unit-admissions and lymphoedema rates were comparable. Discussion Proficiency-based progression training can be used safely to teach robot-assisted laparoscopic surgery for women with endometrial cancer. Prospective trails are needed to further investigate the influence of distinct parts of robot-assisted laparoscopic surgery performed by a trainee on endometrial cancer outcomes.
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Affiliation(s)
- Ariane Sickinghe
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
- Faculty of Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marielle Nobbenhuis
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Ellen Nelissen
- Department of Gynecological Oncology, Royal United Hospitals, Bath, United Kingdom
| | - Owen Heath
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Thomas Ind
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
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Campi R, Pecoraro A, Piramide F, Gallo ML, Serni S, Mottrie A, Territo A, Decaestecker K, Breda A. The ERUS course on robot-assisted kidney transplantation. World J Urol 2024; 42:205. [PMID: 38554210 PMCID: PMC10981625 DOI: 10.1007/s00345-024-04802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/16/2024] [Indexed: 04/01/2024] Open
Abstract
PURPOSE Robot-assisted kidney transplantation (RAKT) is being increasingly performed at selected referral institutions worldwide. Yet, surgical training in RAKT is still unstructured and not grounded into formal credentialing courses including simulation, lab facilities, and modular training with animal models. As such, developing standardized, modular training programs is warranted to provide surgeons with the RAKT-specific skillset needed for a "safe" learning curve. METHODS The 3-day course on RAKT developed at the EAU Skills Center in Orsi Academy was designed as a standardized, modular, step-by-step approach aiming to provide theoretical and practical skills. The course is held by expert proctors with extensive experience in RAKT. To maximize the course's usefulness, a solid knowledge of robotics and transplantation is desirable for participants. RESULTS From January 2016 to July 2023, 87 surgeons from 23 countries (of which 36% from extra-European countries) participated in the RAKT course performed at the EAU Skills Center in Orsi Academy. Of these, 58/87 (67%) were urologists, while 27/87 (31%) were general surgeons and 2/87 (2%) were vascular surgeons. To date, 18 participants (20.6%) are actively involved in RAKT programs at institutions included in the European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT network. CONCLUSION Leveraging the potential of simulation, wet-lab training, live porcine models, and experienced proctors, the RAKT course performed at the EAU Skills Center in Orsi Academy represents the first structured teaching effort aiming to offer surgeons a full immersion in RAKT to train the core technical skills.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
- Chirurgia Urologica Robotica Mini-Invasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Viale San Luca, 50134, Florence, Italy.
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Federico Piramide
- Departement of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Alex Mottrie
- Departement of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Angelo Territo
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Karel Decaestecker
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Alberto Breda
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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Abdulfattah S, Mittal S. Pediatric Robot-Assisted Laparoscopic Pyeloplasty: Where Are We Now? Curr Urol Rep 2024; 25:55-61. [PMID: 38324220 DOI: 10.1007/s11934-024-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide an in-depth exploration of the recent advancements in robot-assisted laparoscopic pyeloplasty (RALP) and its evolving landscape in the context of infant pyeloplasty, complex genitourinary (GU) anatomy, recurrent ureteropelvic junction (UPJ) obstruction, cost considerations, and the learning curve. RECENT FINDINGS Recent literature highlights the safety and efficacy of RALP in treating the infant population, patients with complex GU anomalies, and recurrent UPJO which were all traditionally managed using the open approach. Cost considerations are evolving, with the potential for RALP to have a lesser financial burden. In addition, the learning curve for RALP is diminishing due to robust training programs and advances in research. RALP has become the gold standard in the treatment of UPJO in pediatric urology at many children's hospitals. Surgeon comfort and research in this space allow safe and successful reconstruction in the most challenging of cases.
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Affiliation(s)
- Suhaib Abdulfattah
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Surgery/Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Checcucci E, Puliatti S, Pecoraro A, Piramide F, Campi R, Carrion DM, Esperto F, Afferi L, Veneziano D, Somani B, Vásquez JL, Fiori C, Mottrie A, Amato M, N'Dow J, Porpiglia F, Liatsikos E, Rivas JG, Cacciamani GE. ESRU-ESU-YAU_UROTECH Survey on Urology Residents Surgical Training: Are We Ready for Simulation and a Standardized Program? EUR UROL SUPPL 2024; 61:18-28. [PMID: 38384440 PMCID: PMC10879935 DOI: 10.1016/j.euros.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
Background Currently, the landscape of surgical training is undergoing rapid evolution, marked by the initial implementation of standardized surgical training programs, which are further facilitated by the emergence of new technologies. However, this proliferation is uneven across various countries and hospitals. Objective To offer a comprehensive overview of the existing surgical training programs throughout Europe, with a specific focus on the accessibility of simulation resources and standardized surgical programs. Design setting and participants A dedicated survey was designed and spread in May 2022 via the European Association of Urology (EAU) mail list, to Young Urologist Office (YUO), Junior membership, European Urology Residents Education Program participants between 2014 and 2022, and other urologists under 40 yr, and via the EAU Newsletter. Intervention A 64-item, online-based survey in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) using the platform of Survey Monkey (Portland, OR, USA) was realized. Outcome measurements and statistical analysis The study involved an assessment of the demographic characteristics. Additionally, it explored the type of center, availability of various surgical approaches, presence of training infrastructure, participation in courses, organization of training, and participants' satisfaction with the training program. The level of satisfaction was evaluated using a Likert-5 scale. The subsequent sections delved into surgical training within the realms of open, laparoscopic, robotic, and endoscopic surgery, each explored separately. Finally, the investigation encompassed the presence of a structured training course and the availability of a duly validated final evaluation process. Results and limitations There were 375 responders with a completion rate of 82%. Among them, 75% were identified as male, 50.6% were young urologists, 31.7% were senior residents, and 17.6% were junior residents. A significant majority of participants (69.6%) were affiliated with academic centers. Regarding the presence of dry lab training facilities, only 50.3% of respondents indicated its availability. Among these centers, 46.7% were primarily focused on laparoscopy training. The availability of virtual and wet lab training centers was even more limited, with rates of 31.5% and 16.2%, respectively. Direct patient involvement was reported in 80.5% of cases for open surgery, 58.8% for laparoscopy, 25.0% for robotics, and 78.6% for endourology. It is worth noting that in <25% of instances, training followed a well-defined standardized program comprising both preclinical and clinical modular phases. Finally, the analysis of participant feedback showed that 49.7% of respondents expressed a satisfaction rating of either 4 or 5 points with respect to the training program. The limitations of our study include the low response rate, predominance of participants from academic centers, and absence of responses from individuals not affiliated with the EAU network. Conclusions The current distribution of surgical training centers falls short of ensuring widespread access to standardized training programs. Although dry lab facilities are relatively well spread, the availability of wet lab resources remains restricted. Additionally, it appears that many trainees' initial exposure to surgery occurs directly with patients. There is a pressing need for continued endeavors to establish uniform training routes and assessment techniques across various surgical methodologies. Patient summary Nowadays, the surgical training landscape is heterogeneous across different countries. The implementation of a standardized training methodology to enhance the overall quality of surgical training and thereby improving patient outcomes is needed.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Federico Piramide
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Diego M. Carrion
- Torrejon University Hospital, Madrid, Spain
- Universidad Francisco de Vitoria, Madrid, Spain
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Cristian Fiori
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Francesco Porpiglia
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | | | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
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Frego N, Ruvolo CC, Mottrie A. Opening up the Market to New Robotic Platforms: The Best Way To Handle New Options. Eur Urol 2024; 85:190-192. [PMID: 37394406 DOI: 10.1016/j.eururo.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Nicola Frego
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudia Collà Ruvolo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Ghent, Belgium.
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Pecoraro A, Territo A, Boissier R, Hevia V, Prudhomme T, Piana A, Bañuelos Marco B, Gallagher AG, Serni S, Decaestecker K, Breda A, Campi R. Proposal of a standardized training curriculum for open and robot-assisted kidney transplantation. Minerva Urol Nephrol 2024; 76:110-115. [PMID: 38426425 DOI: 10.23736/s2724-6051.23.05650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Standardized training programs for open (OKT) and robot-assisted kidney transplantation (RAKT) remain unmet clinical needs. To fill this gap, we designed a modified Delphi Consensus aiming to propose the first structured surgical curricula for both OKT and RAKT, involving a multispecialty international panel of experts. Two web-based surveys were built drafting two separate series of statements (for OKT and RAKT, respectively). The two surveys were delivered to a panel of 63 experts (for OKT) and 21 experts (for RAKT), selected considering their experience, academic profile and involvement in international associations. Consensus was defined as ≥75% agreement between the responders. Overall, 25/63 (40%) and 14/21 (67%) participated in the first round of the Delphi Consensus for the development of the structured curriculum for OKT and RAKT, respectively. During the second round, the experts reached consensus on all statements, as well as on the domains composing the structure of the training pathway: 1) eligibility criteria for trainees and host centres; 2) theoretical training; 3) simulation; 4) real case observation; and 5) modular training in the operating theatre. To the best of our knowledge, this is the first proposal of a dedicated curriculum for OKT and RAKT grounded on insights from international experts of different specialties. Our proposed curriculum provides the foundation to standardize the education and training in KT across Europe and beyond.
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Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- European Robotic Urology Section (ERUS), European Association of Urology (EAU), Robot-Assisted Kidney Transplantation (RAKT) Working Group, Arnhem, the Netherlands
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Karel Decaestecker
- European Robotic Urology Section (ERUS), European Association of Urology (EAU), Robot-Assisted Kidney Transplantation (RAKT) Working Group, Arnhem, the Netherlands
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- European Robotic Urology Section (ERUS), European Association of Urology (EAU), Robot-Assisted Kidney Transplantation (RAKT) Working Group, Arnhem, the Netherlands
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy -
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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11
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Moschovas MC, Bravi CA, Dell'Oglio P, Turri F, de Groote R, Liakos N, Wenzel M, Würnschimmel C, Di Maida F, Piramide F, Andras I, Breda A, Mottrie A, Patel V, Larcher A. Current practice and unmet training needs in robotic-assisted radical prostatectomy: investigation from the Junior ERUS/YAU working group. World J Urol 2024; 42:59. [PMID: 38279975 DOI: 10.1007/s00345-023-04713-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/17/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE To access the current scenario of robotic-assisted radical prostatectomy training in multiple centers worldwide. METHODS We created a multiple-choice questionnaire assessing all details of robotic-assisted radical prostatectomy training with 41 questions divided into three different categories (responder demography, surgical steps, and responder experience). The questionnaire was created and disseminated using the "Google Docs" platform. All responders had an individual invitation by direct message or Email. We selected urologists who had recently finished a postgraduation urologic robotic surgery training (fellowship) in the last five years. We sent 624 invitations to urologists from 138 centers, from January 10th to April 10th, 2022. The answers were reported as percentages and illustrated in pie charts. RESULTS The response rate was 58% among all centers invited (138/81), 20% among all individual invitations (122/624 answers). Globally, we gathered responses from 23 countries. Most surgeons were older than 34 years, 71% trained in an academic center, and 64% performed less than ten full RARP cases. Transperitoneal is the most common access, and 63% routinely opens the endopelvic fascia. Almost 90% perform the Rocco's stitch, and 94% perform the anastomosis with barbed sutures. Finally, only 31% of surgeons assisted more than 100 cases before moving to the console, and most surgeons (63.9%) performed less than ten full RARP cases during their training. CONCLUSION By assessing the robotic-assisted radical prostatectomy training status in 23 countries and 81 centers worldwide, we assessed the trainees' demography, step-by-step surgical technique, training perspectives, and impressions of surgeons who trained in the last five years. This data is crucial for a better understanding the trainee's standpoint, addressing potential deficiencies, and implementing improvements needed in the training process. Our study clearly indicates elements of current training modalities that are prone to major improvement.
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Affiliation(s)
- Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, 380 Celebration Pl Suite 401, Celebration, FL, 34747, USA.
- University of Central Florida (UCF), Florida, USA.
- ORSI Academy, Ghent, Belgium.
- University of Florence, Florence, Italy.
| | - Carlo Andrea Bravi
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
- University of Florence, Florence, Italy
| | - Paolo Dell'Oglio
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- University of Florence, Florence, Italy
| | - Filippo Turri
- ASST Santi Paolo e Carlo - La Statale University, Milan, Italy
| | - Ruben de Groote
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- University of Florence, Florence, Italy
| | - Nikolaos Liakos
- University of Freiburg Medical Centre, Freiburg, Germany
- University of Florence, Florence, Italy
| | - Mike Wenzel
- University Hospital, Frankfurt, Germany
- University of Florence, Florence, Italy
| | | | | | - Federico Piramide
- University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
- University of Florence, Florence, Italy
| | - Iulia Andras
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- University of Florence, Florence, Italy
| | - Alberto Breda
- Autonoma University of Barcelona at Fundacio Puigvert, Barcelona, Spain
- University of Florence, Florence, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- University of Florence, Florence, Italy
| | - Vipul Patel
- AdventHealth Global Robotics Institute, 380 Celebration Pl Suite 401, Celebration, FL, 34747, USA
- University of Central Florida (UCF), Florida, USA
- University of Florence, Florence, Italy
| | - Alessandro Larcher
- San Raffaele Hospital, Milan, Italy
- University of Florence, Florence, Italy
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12
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Hermans T, Snoeks JM, vom Dorp F, Wiesner C, Steiner T, von Rundstedt F. Validation of a 3D-printed robot-assisted partial nephrectomy training model. BJUI COMPASS 2024; 5:90-100. [PMID: 38179024 PMCID: PMC10764170 DOI: 10.1002/bco2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives Most renal tumours can be treated with a partial nephrectomy, with robot-assisted partial nephrectomy becoming the new gold standard. This procedure is challenging to learn in a live setting, especially the enucleation and renorraphy phases. In this study, we attempted to evaluate face, content, and preliminary construct validity of a 3D-printed silicone renal tumour model in robotic training for robot-assisted partial nephrectomy. Materials and Methods We compared the operative results of three groups of surgeons with different experience levels (>20 partial nephrectomies, 1-20 partial nephrectomies and no experience at all) performing a robotic tumour excision of a newly developed silicone model with four embedded 3D-printed renal tumours. We evaluated the participants' performance using surgical margins, excision time, total preserved parenchyma, tumour injury and GEARS score (as assessed by two blinded experts) for construct validity. Postoperatively, the participants were asked to complete a survey to evaluate the usefulness, realism and difficulty of the model as a training and/or evaluation model. NASA-TLX scores were used to evaluate the operative workload. Results Thirty-six participants were recruited, each group consisting of 10-14 participants. The operative performance was significantly better in the expert group as compared to the beginner group. NASA-TLX scores proved the model to be of an acceptable difficulty level.Expert group survey results showed an average score of 6.3/10 on realism of the model, 8.2/10 on the usefulness as training model and 6.9/10 score on the usefulness as an evaluation tool. GEARS scores showed a non-significant tendency to improve between trials, emphasizing its potential as a training model. Conclusion Face and content validity of our 3D renal tumour model were demonstrated. The vast majority of participants found the model realistic and useful for training and for evaluation. To evaluate construct and predictive validity, we require further research, aiming to compare the results of 3D-model trained surgeons with those of untrained surgeons in real-life surgery.
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Affiliation(s)
- Thomas Hermans
- Department of UrologyHelios University Hospital Wuppertal, University of Witten/HerdeckeWuppertalGermany
| | - Joren M. Snoeks
- Community Ecology Lab, Department of BiologyVrije Universiteit Brussel (VUB)BrusselsBelgium
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13
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Paciotti M, Piramide F, Bravi CA, Dell'oglio P, Turri F, DI Maida F, DE Groote R, Lambert E, Wurnschimmel C, Larcher A. Retroperitoneal approach for robot-assisted partial nephrectomy: still underused despite the supporting evidence. Minerva Urol Nephrol 2023; 75:652-655. [PMID: 37728499 DOI: 10.23736/s2724-6051.23.05530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy -
| | - Carlo A Bravi
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Paolo Dell'oglio
- Department of Urology, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Fabrizio DI Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Ruben DE Groote
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Edward Lambert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
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14
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Bravi CA, Dell'Oglio P, Mazzone E, Moschovas MC, Falagario U, Piazza P, Scarcella S, Bednarz C, Sarchi L, Tappero S, Knipper S, De Groote R, Sjoberg D, Schiavina R, Suardi N, Terrone C, Autorino R, Carrieri G, Galosi A, Galfano A, Briganti A, Montorsi F, Patel V, Vickers A, Mottrie A. The Surgical Learning Curve for Biochemical Recurrence After Robot-assisted Radical Prostatectomy. Eur Urol Oncol 2023; 6:414-421. [PMID: 35850976 PMCID: PMC10795739 DOI: 10.1016/j.euo.2022.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP). OBJECTIVE To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery. RESULTS AND LIMITATIONS Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses. CONCLUSIONS These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve. PATIENT SUMMARY We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.
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Affiliation(s)
- Carlo A Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Ugo Falagario
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Piazza
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Scarcella
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy
| | | | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Sophie Knipper
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Daniel Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nazareno Suardi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Galosi
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
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Siech C, Fassbach M, Neutzer M, Beverungen H. [Status quo of urological residency training in Germany-a strengths, weaknesses, opportunities, and threats (SWOT) analysis]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02131-3. [PMID: 37405422 DOI: 10.1007/s00120-023-02131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Urological residency training is a decisive step on the urological career path. The aim of this review is to develop strategies and approaches to actively shape, improve and further develop urological residency training. METHODS With the help of a strengths, weaknesses, opportunities, and threats (SWOT) analysis, the status quo of urological residency training in Germany is analyzed in a structured manner. RESULTS Strengths of urological residency training incorporate the attractiveness of the specialty itself, and the residency training curriculum in urology ("Weiterbildungscurriculum Urologie", WECU), including the networking of inpatient and outpatient training and accompanying internal and external further training. The German Society of Residents in Urology (GeSRU) also provides a networking platform for residents. Weaknesses include country-specific differences and a lack of checkpoints during residency training. Opportunities for urological continuing education arise from freelance work, digitalization, and technical and medical progress. In contrast, the aftermath of the coronavirus disease 2019 (COVID 19) pandemic, with still limited staff and surgical capacities, an increased psychosocial workload, and the rising number of outpatient treatments in urology pose threats for urological residency programs. CONCLUSIONS With the help of a SWOT analysis, factors for the further development of urological residency training can be identified. In order to provide high-quality residency training in the future, strengths and opportunities should be consolidated and weaknesses and threats should be addressed at an early stage.
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Affiliation(s)
- Carolin Siech
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Mira Fassbach
- Klinik Urologie, urologische Onkologie und Kinderurologie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - Maike Neutzer
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer Krefeld GmbH, Krefeld, Deutschland
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Harji D, Houston F, Burke J, Griffiths B, Tilney H, Miskovic D, Evans C, Khan J, Soomro N, Bach SP. The current status of robotic colorectal surgery training programmes. J Robot Surg 2023; 17:251-263. [PMID: 35657506 DOI: 10.1007/s11701-022-01421-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
Robotic-assisted colorectal surgery (RACS) is steadily increasing in popularity with an annual growth in the number of colorectal procedures undertaken robotically. Further upscaling of RACS requires structured and standardised robotic training to safeguard high-quality clinical outcomes. The aims of this systematic review were to assess the structure and assessment metrics of currently established RACS training programmes. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines was performed. Searches were performed of the Ovid Medline, Embase and Web of Science databases between 2000 and 27th November 2021 to identify studies reporting on training curricula in RACS. Core components of training programmes and their relevant outcome assessment metrics were extracted. Thirteen studies were identified, with all training programmes designed for the da Vinci platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Common elements of multimodal programmes included theoretical knowledge (76.9%), case observation (53.8%), simulation (100%) and proctored training (76.9%). Robotic skills acquisition was assessed primarily during the simulation phase (n = 4, 30.1%) and proctoring phase (n = 10, 76.9%). Performance metrics, consisting of time or assessment scores for VR simulation were only mandated in four (30.1%) studies. Objective assessment following proctored training was variably reported and employed a range of assessment metrics, including direct feedback (n = 3, 23.1%) or video feedback (n = 8, 61.5%). Five (38.4%) training programmes used the Global Assessment Score (GAS) forms. There is a broad consensus on the core multimodal components across current RACS training programmes; however, validated objective assessment is limited and needs to be appropriately standardised to ensure reproducible progression criteria and competency-based metrics are produced to robustly assess progression and competence.
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Affiliation(s)
- Deena Harji
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England.
| | | | - Joshua Burke
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Ben Griffiths
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Henry Tilney
- Department of Colorectal Surgery, Frimley Health NHS Foundation Trust, Frimley, Surrey, England
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Danilo Miskovic
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - Charles Evans
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Naeem Soomro
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon P Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
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17
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Larcher A, Cei F, Belladelli F, Rosiello G, Andrea Bravi C, Fallara G, Basile G, Lucianò R, Karakiewicz P, Mottrie A, Breda A, Briganti A, Salonia A, Bertini R, Montorsi F, Capitanio U. The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training. EUR UROL SUPPL 2023; 49:11-14. [PMID: 36874599 PMCID: PMC9975008 DOI: 10.1016/j.euros.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 01/21/2023] Open
Abstract
Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1-3a cN0 cM0 renal mass. EXP was defined as the total number of RNs performed by each surgeon before the patient's operation. The primary study outcomes were all-cause mortality, clinical progression, Clavien-Dindo grade ≥2 postoperative complications (CD ≥2), and the estimated glomerular filtration rate (eGFR). Secondary outcomes were operative time, estimated blood loss, and length of stay. Multivariable analyses adjusted for case mix revealed no evidence of association between EXP and all-cause mortality (p = 0.7), clinical progression (p = 0.2), CD ≥2 (p = 0.6), or 12-mo eGFR (p = 0.9). Conversely, EXP was associated with shorter operative time (estimate -0.9; p < 0.01). Mortality, cancer control, morbidity, and renal function might not be affected by EXP. The very large cohort examined and the extensive follow-up support the validity of these negative findings. Patient summary For patients with kidney cancer undergoing surgical removal of a kidney, those treated by novice surgeons have similar clinical outcomes to those treated by experienced surgeons. Thus, this procedure represents a convenient scenario for surgical training if longer operating theatre time can be planned.
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Affiliation(s)
- Alessandro Larcher
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Cei
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Belladelli
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Basile
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Lucianò
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Alberto Briganti
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Bertini
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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18
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Larcher A, Belladelli F, Capitanio U, Montorsi F. Long-distance Robot-assisted Teleoperation: Every Millisecond Counts. Eur Urol 2023; 83:45-47. [PMID: 36243542 DOI: 10.1016/j.eururo.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Larcher
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Clinical Oncology, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Federico Belladelli
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Clinical Oncology, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Umberto Capitanio
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Clinical Oncology, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Clinical Oncology, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
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19
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Pecoraro A, Andras I, Boissier R, Hevia V, Prudhomme T, Serni S, Breda A, Campi R, Territo A. The learning curve for open and minimally-invasive kidney transplantation: a systematic review. Minerva Urol Nephrol 2022; 74:669-679. [PMID: 35622352 DOI: 10.23736/s2724-6051.22.04909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is lack of evidence on the impact of surgeons' learning curve on postoperative outcomes after open (OKT) or minimally-invasive (robot-assisted) kidney transplantation (RAKT). The aim of the review was to assess the learning curve (LC) for OKT and RAKT, focusing on intra-, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the English-language literature published between 01/01/2000 - 10/12/2021 was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42022301132). The overall quality of evidence was assessed according to GRADE recommendations. EVIDENCE SYNTHESIS Twelve studies were included in the qualitative analysis. Surgical competence in terms of operative and re-warming times was defined after 30 cases in OKT and after 11-35 cases in RAKT. Decreased complications rates were observed after 20-33 cases in OKT and 10-30 cases in RAKT. Optimal functional outcomes were achieved after 33 cases in OKT and 15-25 cases in RAKT. However, while a poor OKT experience did not influence the LC for RAKT, lack of robotic surgery exposure could lead to a longer LC for the robotic approach. CONCLUSIONS OKT and RAKT appear to have similar LCs and might require about 30 cases to achieve optimal surgical and functional outcomes. Previous expertise in OKT is warranted to shorten the LC for RAKT. Further research is needed to validate these thresholds using standardized reporting metrics.
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Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain -
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20
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Harke NN, Kuczyk MA, Huusmann S, Schiefelbein F, Schneller A, Schoen G, Wiesinger C, Pfuner J, Ubrig B, Gloger S, Osmonov D, Eraky A, Witt JH, Liakos N, Wagner C, Hadaschik BA, Radtke JP, Al Nader M, Imkamp F, Siemer S, Stöckle M, Zeuschner P. Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients. EUR UROL SUPPL 2022; 46:45-52. [PMID: 36506259 PMCID: PMC9732453 DOI: 10.1016/j.euros.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. Objective To assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design setting and participants In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon's experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. Intervention Transperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysis The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitations BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p < 0.001) and WIT (p < 0.001) and improved the MIC rate (p = 0.022). A greater number of prior robotic pelvic interventions decreased WIT (p = 0.011) and the rate of major complications (p < 0.001) and increased the MIC rate (p = 0.011), while prior experience in open kidney surgery did not. One limitation is the short-term follow-up. Conclusions Mastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. Patient summary In this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.
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Affiliation(s)
- Nina N. Harke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Markus A. Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Stephan Huusmann
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Frank Schiefelbein
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Andreas Schneller
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Georg Schoen
- Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany
| | - Clemens Wiesinger
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Burkhard Ubrig
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Simon Gloger
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Daniar Osmonov
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ahmed Eraky
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jörn H. Witt
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Christian Wagner
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | | | | | - Mulham Al Nader
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Florian Imkamp
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
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21
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Siech C, García CC, Leyh H, Schmid HP, Engl TA, Karakiewicz PI, Becker A, Chun FKH, Banek S, Kluth LA. Standardized evaluation of satisfaction within urology residents during clinical training: Implementation of a new urological residency rotation program at the university hospital Frankfurt. Front Surg 2022; 9:1038336. [PMID: 36504575 PMCID: PMC9727092 DOI: 10.3389/fsurg.2022.1038336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Structured curricula are demanded to improve training programs of future urologists. This study aimed to evaluate the acceptance of the newly implemented residency rotation program at the University Hospital Frankfurt. Primary endpoint was resident's satisfaction with the current residency rotation program. Secondary endpoint was the fulfilment of the objectives and expectations by residents. Methods A standardized 15-item, online-based survey was sent to every urologic resident of the University Hospital Frankfurt, completing their rotation between August 2020 and August 2022. In addition to baseline characteristics, training and working conditions were assessed. Descriptive statistics were applied. Results In total 15 rotations of the Residency Rotation Program at the University Hospital Frankfurt were evaluated, including urologic practice (5/15), Intermediate Care Unit (4/15), urooncology (4/15) and clinical exchange to St. Gallen (2/15). Overall, the majority were very (67%) or rather satisfied (2%) with their rotation. Of the pre-rotation defined objectives, 71% were fulfilled, 18% partially fulfilled and 8% not fulfilled. With respect to the expectations, 67% were fulfilled, 19% partly fulfilled and 4% were not fulfilled. All residents would recommend their respective rotations. Conclusion Our results demonstrate that the residency rotation program at the University Hospital Frankfurt enjoys a high level of acceptance as well as a positive impact on urologic training. Satisfaction with the completed rotation was convincing, most of the expectations and objectives for the respective rotation could be fulfilled. These results help to ensure the quality of urologic curricula and to improve the structure of training programs for future urologists.
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Affiliation(s)
- Carolin Siech
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany,Correspondence: Carolin Siech
| | - Cristina Cano García
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada,Correspondence: Carolin Siech
| | | | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | | | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Felix K-H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Séverine Banek
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
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22
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Khan MTA, Patnaik R, Lee CS, Willson CM, Demario VK, Krell RW, Laverty RB. Systematic review of academic robotic surgery curricula. J Robot Surg 2022; 17:719-743. [DOI: 10.1007/s11701-022-01500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
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23
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Cacciamani GE, Sholklapper T, Dell'Oglio P, Rocco B, Annino F, Antonelli A, Amenta M, Borghesi M, Bove P, Bozzini G, Cafarelli A, Celia A, Leonardo C, Ceruti C, Cindolo L, Crivellaro S, Dalpiaz O, Falabella R, Falsaperla M, Galfano A, Gallo F, Greco F, Minervini A, Parma P, Chiara Sighinolfi M, Pastore AL, Pini G, Porreca A, Pucci L, Sciorio C, Schiavina R, Umari P, Varca V, Veneziano D, Verze P, Volpe A, Zaramella S, Lebastchi A, Abreu A, Mitropoulos D, Shekhar Biyani C, Sotelo R, Desai M, Artibani W, Gill I. The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project: Development of Criteria for Reporting Adverse Events During Surgical Procedures and Evaluating Their Impact on the Postoperative Course. Eur Urol Focus 2022; 8:1847-1858. [PMID: 35177353 DOI: 10.1016/j.euf.2022.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. OBJECTIVE To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. DESIGN, SETTING, AND PARTICIPANTS The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS AND LIMITATIONS The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. CONCLUSIONS The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. PATIENT SUMMARY We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
| | - Tamir Sholklapper
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bernardo Rocco
- Urological Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | | | - Michele Amenta
- Department of Urology, Azienda ULSS n.4 Veneto Orientale, Portogruaro, Italy
| | | | | | | | | | - Antonio Celia
- Urology Unit, Ospedale San Bassiano, Bassano del Grappa, Italy
| | | | - Carlo Ceruti
- Urology Unit, AOU Citta della Salute e della Scienza, Turin, Italy
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, Mantova, Italy
| | | | | | | | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Luigi Pucci
- Urology Unit, Azienda Ospedaliera A. Cardarelli, Naples, Italy
| | | | | | - Paolo Umari
- Urology Unit, Ospedale Maggiore della Carita, Novara, Italy
| | - Virginia Varca
- Urology Unit, ASAT Rhodense Ospedale Guido Salvini di Garbagnate, Garbagnate, Italy
| | | | - Paolo Verze
- Urology Unit, AOU San Giovanni di Rio e Ruggi d'Aragona, Salerno, Italy
| | | | | | - Amir Lebastchi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Dionysios Mitropoulos
- Department of Urology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Chandra Shekhar Biyani
- Department of Urology, St. James' Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rene Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Inderbir Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
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Farinha R, Breda A, Porter J, Mottrie A, Van Cleynenbreugel B, Vander Sloten J, Mottaran A, Gallagher AG. International Expert Consensus on Metric-based Characterization of Robot-assisted Partial Nephrectomy. Eur Urol Focus 2022; 9:388-395. [PMID: 36229343 DOI: 10.1016/j.euf.2022.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Robot-assisted partial nephrectomy (RAPN) training usually takes place in vivo, and methods vary across countries/institutions. No common system exists to objectively assess trainee ability to perform RAPN at predetermined performance levels prior to in vivo practice. The identification of objective performance metrics for RAPN training is a crucial starting point to improve training and surgical outcomes. OBJECTIVE We sought to identify objective performance metrics that best characterize a reference approach to RAPN, and obtain face and content validity from procedure experts through a modified Delphi meeting. DESIGN, SETTING, AND PARTICIPANTS During a series of online meetings, a core metrics team of three RAPN experts and a senior behavioral scientist performed a detailed task deconstruction of a transperitoneal left-sided RAPN procedure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on published guidelines, manufacturers' instructions, and unedited videos of RAPN, the team identified performance metrics that constitute an optimal approach for training purposes. The metrics were then subjected to an in-person modified international Delphi panel meeting with 19 expert surgeons. RESULTS AND LIMITATIONS Eleven procedure phases, with 64 procedure steps, 43 errors, and 39 critical errors, were identified. After the modified Delphi process, the international expert panel added 13 metrics (two steps), six were deleted, and three were modified; 100% panel consensus on the resulting metrics was obtained. Limitations are that the metrics are applicable only to left-sided RAPN cases and some might have been excluded. CONCLUSIONS Performance metrics that accurately characterize RAPN procedure were developed by a core group of experts. The metrics were then presented to and endorsed by an international panel of very experienced peers. Reliable and valid metrics underpin effective, quality-assured, structured surgical training for RAPN. PATIENT SUMMARY We organize a meeting among robot-assisted partial nephrectomy (RAPN) experts to identify and reach consensus on objective performance metrics for RAPN training. The metrics are a crucial starting point to improve and quality assure surgical training and patients' clinical outcomes.
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Wijburg CJ, Hannink G, Michels CT, Weijerman PC, Issa R, Tay A, Decaestecker K, Wiklund P, Hosseini A, Sridhar A, Kelly J, d'Hondt F, Mottrie A, Klaver S, Edeling S, Dell'Oglio P, Montorsi F, Rovers MM, Witjes JA. Learning Curve Analysis for Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section Scientific Working Group. EUR UROL SUPPL 2022; 39:55-61. [PMID: 35528784 PMCID: PMC9068730 DOI: 10.1016/j.euros.2022.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure. Objective To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade ≥3), 90-d overall complications (OC90, Clavien-Dindo grades 1–5), operating time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). Design, setting, and participants This was a retrospective analysis of all consecutive iRARC cases from nine European high-volume hospitals with ≥100 cases. All patients had bladder cancer for which iRARC was performed, with an ileal conduit or neobladder as the urinary diversion. Outcome measurements and statistical analysis Outcome parameters used as a proxy for LC length were the number of consecutive cases needed to reach a plateau level in two-piece mixed-effects models for MC90, OC90, OT, EBL, and LOS. Results and limitations A total of 2186 patients undergoing iRARC between 2003 and 2018were included. The plateau levels for MC90 and OC90 were reached after 137 cases (95% confidence interval [CI] 80–193) and 97 cases (95% CI 41–154), respectively. The mean MC90 rate at the plateau was 14% (95% CI 7–21%). The plateau level was reached after 75 cases (95% CI 65–86) for OT, 88 cases (95% CI 70–106) for EBL, and 198 cases (95% CI 130–266) for LOS. A major limitation of the study is the difference in the balance of urinary diversion types between centres. Conclusions This multicentre retrospective analysis for the iRARC LC among nine European centres showed that 137 consecutive cases were needed to reach a stable MC90 rate. Patient summary We carried out a multicentre analysis of the surgical learning curve for robot-assisted removal of the bladder and bladder reconstruction in patients with bladder cancer. We found that 137 consecutive cases were needed to reach a stable rate of serious complications.
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Amparore D, Piramide F, De Cillis S, Verri P, Piana A, Pecoraro A, Burgio M, Manfredi M, Carbonara U, Marchioni M, Campi R, Fiori C, Checcucci E, Porpiglia F. Robotic partial nephrectomy in 3D virtual reconstructions era: is the paradigm changed? World J Urol 2022; 40:659-670. [PMID: 35191992 DOI: 10.1007/s00345-022-03964-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
CONTEXT The development of a tailored, patient-specific medical and surgical approach is becoming object of intense research. In kidney oncologic surgery, where a clear understanding of case-specific surgical anatomy is considered a key point to optimize the perioperative outcomes, such philosophy gained increasing importance. Recently, important advances in 3D virtual modeling technologies have fueled the interest for their application in the field of robotic minimally invasive surgery for kidney tumors. OBJECTIVE To provide a synthesis of current applications of 3D virtual models for robot-assisted partial nephrectomy. EVIDENCE ACQUISITION Medline, PubMed, the Cochrane Database, and Embase were screened for Literature regarding the use of 3D virtual models for robot-assisted partial nephrectomy (RAPN). EVIDENCE SYNTHESIS The use of 3D virtual models for RAPN has been tested in different settings, including surgical indication and planning, intraoperative guidance, and training. Currently, several studies are available on the application of this technology for surgical planning, demonstrating impact on clinical outcomes such as renal function recovery, whilst experiences concerning their intraoperative application for navigation are still experimental. One of the latest innovations in this field is represented by the development of dedicated softwares able to automatically overlap the 3D virtual models to the real anatomy, to perform augmented reality procedures. CONCLUSIONS The available Literature suggests a potentially crucial role of 3D virtual reconstructions during RAPN. Encouraging results concerning surgical planning and indication, intraoperative navigation, and surgical training are available. In the future, artificial intelligence may represent the key to further improve the 3D virtual modeling technology during RAPN.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
- Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
- Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
| | - Mariano Burgio
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Umberto Carbonara
- Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Michele Marchioni
- Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Riccardo Campi
- Renal Cancer Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
- Uro-Technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano (Turin), Italy.
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Definition of a Structured Training Curriculum for Robot-assisted Radical Cystectomy with Intracorporeal Ileal Conduit in Male Patients: A Delphi Consensus Study Led by the ERUS Educational Board. Eur Urol Focus 2022; 8:160-164. [PMID: 33402314 PMCID: PMC9435953 DOI: 10.1016/j.euf.2020.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/14/2020] [Accepted: 12/18/2020] [Indexed: 01/03/2023]
Abstract
Robot-assisted radical cystectomy (RARC) continues to expand, and several surgeons start training for this complex procedure. This calls for the development of a structured training program, with the aim to improve patient safety during RARC learning curve. A modified Delphi consensus process was started to develop the curriculum structure. An online survey based on the available evidence was delivered to a panel of 28 experts in the field of RARC, selected according to surgical and research experience, and expertise in running training courses. Consensus was defined as ≥80% agreement between the responders. Overall, 96.4% experts completed the survey. The structure of the RARC curriculum was defined as follows: (1) theoretical training; (2) preclinical simulation-based training: 5-d simulation-based activity, using models with increasing complexity (ie, virtual reality, and dry- and wet-laboratory exercises), and nontechnical skills training session; (3) clinical training: modular console activity of at least 6 mo at the host center (a RARC case was divided into 11 steps and steps of similar complexity were grouped into five modules); and (4) final evaluation: blind review of a video-recorded RARC case. This structured training pathway will guide a starting surgeon from the first steps of RARC toward independent completion of a full procedure. Clinical implementation is urgently needed. PATIENT SUMMARY: Robot-assisted radical cystectomy (RARC) is a complex procedure. The first structured training program for RARC was developed with the goal of aiding surgeons to overcome the learning curve of this procedure, improving patients' safety at the same time.
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Yu H, Yu Q, Nie Y, Xu W, Pu Y, Dai W, Wei X, Shi Q. Data Quality of Longitudinally Collected Patient-Reported Outcomes After Thoracic Surgery: Comparison of Paper- and Web-Based Assessments. J Med Internet Res 2021; 23:e28915. [PMID: 34751657 PMCID: PMC8663677 DOI: 10.2196/28915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 10/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background High-frequency patient-reported outcome (PRO) assessments are used to measure patients' symptoms after surgery for surgical research; however, the quality of those longitudinal PRO data has seldom been discussed. Objective The aim of this study was to determine data quality-influencing factors and to profile error trajectories of data longitudinally collected via paper-and-pencil (P&P) or web-based assessment (electronic PRO [ePRO]) after thoracic surgery. Methods We extracted longitudinal PRO data with 678 patients scheduled for lung surgery from an observational study (n=512) and a randomized clinical trial (n=166) on the evaluation of different perioperative care strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung Cancer Module and single-item Quality of Life Scale before surgery and then daily after surgery until discharge or up to 14 days of hospitalization. Patient compliance and data error were identified and compared between P&P and ePRO. Generalized estimating equations model and 2-piecewise model were used to describe trajectories of error incidence over time and to identify the risk factors. Results Among 678 patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of patients had at least one error, including (1) missing items (64.69%, 1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3) selection of multiple options (3.02%, 50/1654), (4) missing patient signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%, 24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who completed ePRO had fewer errors than those who completed P&P assessments (ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P<.001). Compared with ePRO patients, those using P&P were older, less educated, and sicker. Common risk factors of having errors were a lower education level (P&P: odds ratio [OR] 1.39, 95% CI 1.20-1.62; P<.001; ePRO: OR 1.82, 95% CI 1.22-2.72; P=.003), treated in a provincial hospital (P&P: OR 3.34, 95% CI 2.10-5.33; P<.001; ePRO: OR 4.73, 95% CI 2.18-10.25; P<.001), and with severe disease (P&P: OR 1.63, 95% CI 1.33-1.99; P<.001; ePRO: OR 2.70, 95% CI 1.53-4.75; P<.001). Errors peaked on postoperative day (POD) 1 for P&P, and on POD 2 for ePRO. Conclusions It is possible to improve data quality of longitudinally collected PRO through ePRO, compared with P&P. However, ePRO-related sampling bias needs to be considered when designing clinical research using longitudinal PROs as major outcomes.
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Affiliation(s)
- Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chonqqing, China
| | - Qingsong Yu
- School of Public Health and Management, Chongqing Medical University, Chonqqing, China
| | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wei Xu
- School of Public Health and Management, Chongqing Medical University, Chonqqing, China
| | - Yang Pu
- School of Public Health and Management, Chongqing Medical University, Chonqqing, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiuling Shi
- School of Public Health and Management, Chongqing Medical University, Chonqqing, China.,State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Myers AA, Geldmaker LE, Haehn DA, Bajalia EM, Ball CT, Thiel DD. Evaluation of Peri-operative Outcomes Associated With Resident Involvement on Tumor Resection and Renorrhaphy During Robotic-assisted Partial Nephrectomy. Urology 2021; 157:143-147. [PMID: 34461143 DOI: 10.1016/j.urology.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate perioperative outcomes of resident trainee involvement in tumor resection and renorrhaphy during robotic assisted partial nephrectomy (RAPN). MATERIALS AND METHODS We analyzed 500 consecutive RAPN in a single surgeon prospectively maintained database. Cases with resident performed tumor resection and renorrhaphy (N = 71) were case matched on R.E.N.A.L. score and RAPN year using a greedy matching algorithm. Perioperative variables were compared to attending cases. RESULTS There were no statistically significant differences in high grade postoperative complications (resident: 3% vs attending: 6%, P = .68), positive margins (resident: 1% vs attending: 3%, P = .31), length of stay (resident: 2.0 vs attending: 2.0 days, P = .73), and 30 day readmission (resident: 7% vs attending: 11%, P = .56). However, residents had a statistically significant longer warm ischemia time (median 21 vs 15 minutes, P <.001), thus less likely to achieve trifecta (66% vs 85%, P = .02). Resident involvement had longer median operative time (197 vs 184 minutes, P = .03). No statistically significant difference in functional volume loss (P = .12) or surface intermediate base margin score (P = .66) between residents and attending was found. No difference in post-operative creatinine change was found at 1 day and 1 month (resident: 0.2 vs attending: 0.1 mg/dL, P = .4 and resident: 0.1 vs attending: 0.1 mg/dL, P = .6, respectively). CONCLUSION Supervised resident console involvement in tumor resection and renorrhaphy during RAPN is safe and does not increase rates of complications. Residents have longer median warm ischemia time compared to attending only cases, but this does not appear to impact post-operative renal function.
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Affiliation(s)
| | | | | | | | - Colleen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL.
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Sessa F, Campi R, Granieri S, Tuccio A, Polverino P, Spatafora P, Sebastianelli A, Cocci A, Rivetti A, Gacci M, Carini M, Serni S, Oriti R, Minervini A. Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience. Front Surg 2021; 8:705105. [PMID: 34395511 PMCID: PMC8358301 DOI: 10.3389/fsurg.2021.705105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate. Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate. Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times. Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.
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Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Granieri
- Azienda Socio-Sanitaria Territoriale (ASST)-Brianza, General Surgery Unit, Vimercate, Italy
| | - Agostino Tuccio
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Unit of Urology, S.Stefano Hospital, University of Florence, Prato, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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Martini A, Turri F, Barod R, Rocco B, Capitanio U, Briganti A, Montorsi F, Mottrie A, Challacombe B, Lagerveld BW, Bensalah K, Abaza R, Badani KK, Mehrazin R, Buscarini M, Larcher A. Salvage Robot-assisted Renal Surgery for Local Recurrence After Surgical Resection or Renal Mass Ablation: Classification, Techniques, and Clinical Outcomes. Eur Urol 2021; 80:730-737. [PMID: 34088520 DOI: 10.1016/j.eururo.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/06/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Salvage treatment for local recurrence after prior partial nephrectomy (PN) or local tumor ablation (LTA) for kidney cancer is, as of yet, poorly investigated. OBJECTIVE To classify the treatments and standardize the nomenclature of salvage robot-assisted renal surgery, to describe the surgical technique for each scenario, and to investigate complications, renal function, and oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS Sixty-seven patients underwent salvage robot-assisted renal surgery from October 2010 to December 2020 at nine tertiary referral centers. SURGICAL PROCEDURE Salvage robot-assisted renal surgery classified according to treatment type as salvage robot-assisted partial or radical nephrectomy (sRAPN or sRARN) and according to previous primary treatment (PN or LTA). MEASUREMENTS Postoperative complications, renal function, and oncologic outcomes were assessed. RESULTS AND LIMITATIONS A total of 32 and 35 patients underwent salvage robotic surgery following PN and LTA, respectively. After prior PN, two patients underwent sRAPN, while ten underwent sRARN for a metachronous recurrence in the same kidney. No intra- or perioperative complication occurred. For local recurrence in the resection bed, six patients underwent sRAPN, while 14 underwent sRARN. For sRAPN, the intraoperative complication rate was 33%; there was no postoperative complication. For sRARN, there was no intraoperative complication and the postoperative complication rate was 7%. At 3 yr, the local recurrence-free rates were 64% and 82% for sRAPN and sRARN, respectively, while the 3-yr metastasis-free rates were 80% and 79%, respectively. At 33 mo, the median estimated glomerular filtration rates (eGFRs) were 57 and 45 ml/min/1.73 m2 for sRAPN and sRARN, respectively. After prior LTA, 35 patients underwent sRAPN and no patient underwent sRARN. There was no intraoperative complication; the overall postoperative complications rate was 20%. No local recurrence occurred. The 3-yr metastasis-free rate was 90%. At 43 mo, the median eGFR was 38 ml/min/1.73 m2. The main limitations are the relatively small population and the noncomparative design of the study. CONCLUSIONS Salvage robot-assisted surgery has a safe complication profile in the hands of experienced surgeons at high-volume institutions, but the risk of local recurrence in this setting is non-negligible. PATIENT SUMMARY Patients with local recurrence after partial nephrectomy or local tumor ablation should be aware that further treatment with robot-assisted surgery is not associated with a worrisome complication profile, but also that they are at risk of further recurrence.
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Affiliation(s)
- Alberto Martini
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Turri
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Ravi Barod
- Specialist Centre for Kidney Cancer Royal Free Hospital, London, UK
| | - Bernardo Rocco
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Umberto Capitanio
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Ben Challacombe
- Department of Urology, Guys and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Ronney Abaza
- Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Maurizio Buscarini
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alessandro Larcher
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
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Farinha R, Rosiello G, Puliatti S, Mottrie A. Reply to Nikolaos Grivas and Henk G. van der Poel's Letter to the Editor re: Rui Farinha, Giuseppe Rosiello, Artur De Oliveira Paludo, et al. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2021.03.019. Eur Urol Focus 2021; 8:888-889. [PMID: 34031018 DOI: 10.1016/j.euf.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rui Farinha
- ORSI Academy, Melle, Belgium; Department of Urology, OLV, Aalst, Belgium; Urology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; Urology Department, Lusíadas Hospital, Lisbon, Portugal.
| | - Giuseppe Rosiello
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium; Department of Urology, OLV, Aalst, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, OLV, Aalst, Belgium
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Carbonara U, Simone G, Minervini A, Sundaram CP, Larcher A, Lee J, Checcucci E, Fiori C, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Ditonno P, Battaglia M, Brassetti A, Bove A, Mari A, Campi R, Carini M, Sulek J, Montorsi F, Capitanio U, Eun D, Porpiglia F, Derweesh I, Autorino R. Outcomes of robot-assisted partial nephrectomy for completely endophytic renal tumors: A multicenter analysis. Eur J Surg Oncol 2021; 47:1179-1186. [DOI: 10.1016/j.ejso.2020.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
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Chowdhury A, Tan LGL, Chiong E, Rha KH, Tiong HY. Transitioning to robotic partial nephrectomy with a team-based proctorship achieves the desired improved outcomes over open and laparoscopic partial nephrectomy. Updates Surg 2021; 73:1189-1196. [PMID: 33891279 DOI: 10.1007/s13304-021-01028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Proctoring may facilitate a safe transition to robotic-assisted partial nephrectomy (RAPN) for centres performing open (OPN) and laparoscopic partial nephrectomies (LPN). This study compared the 5-year outcomes of RAPN, initiated with a team-based proctorship, with OPN and LPN. Following an observation course at the proctor's institution and a 3-surgeon performance of proctored RAPN in August 2014, a review of 90 RAPN, 29 LPN and 43 OPN consecutively performed by the same team from 2013 to 2019 at National University Hospital, Singapore was conducted. Peri-operative data, functional and oncological outcomes were compared amongst the three groups. Most cases were performed robotically after 2015 with comparable baseline characteristics in all groups. Median RENAL Nephrometry Score was not significantly different between RAPN (8 [IQR 6, 9]) and OPN (9 [IQR 7, 10]) (P = 0.12) but was significantly lower for LPN (7 [IQR 5, 8]) compared to RAPN (P = 0.002). RAPN achieved the lowest blood loss (226 ml vs.348 ml and 263 ml for OPN and LPN respectively, P = 0.02), transfusion rate (3% vs.21% and 17% respectively, P = 0.003) and median length of stay after surgery (4 vs.6 and 5 days respectively, P = 0.001). Complication rates, warm ischemic times were similar between the three approaches with no differences in 1-year and long-term renal function. The rate of positive surgical margin was 8%, 8% and 3% for RAPN, LPN and OPN, respectively (P = 0.76), with a single recurrence in each arm. Despite modest hospital volume, a team-based proctorship facilitated the transition to the Da Vinci robotic platform to perform partial nephrectomies of equivalent complexities as open surgery, achieving improved perioperative outcomes, while maintaining oncological and kidney functional results.
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Affiliation(s)
- Asrif Chowdhury
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Severance Hospital, Yongsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore.
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35
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Amparore D, Pecoraro A, Checcucci E, DE Cillis S, Piramide F, Volpi G, Piana A, Verri P, Granato S, Sica M, Manfredi M, Fiori C, Autorino R, Porpiglia F. 3D imaging technologies in minimally-invasive kidney and prostate cancer surgery: which is the urologists' perception? Minerva Urol Nephrol 2021; 74:178-185. [PMID: 33769019 DOI: 10.23736/s2724-6051.21.04131-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many specific 3D imaging technologies are currently available for the practising urologists. Aim of the study was to assess their perception about different 3D imaging tools in the field of prostate and kidney cancer surgery. METHODS All the attendees of the 8th Techno-Urology-Meeting were asked to fill a questionnaire regarding the role of 3D virtual reconstruction PDFs, 3D printing models, Augmented-Reality (AR) and mixed reality technology in the setting of surgical planning, patient counselling, intraoperative guidance and training for kidney and prostate cancer surgery; Moreover the different materials used for 3D printing were compared to assess the most suitable in reproducing the organ and tumor features, as well as their estimated cost and production time. RESULTS The population consisted of 180 attendees. Overall, AR was the preferred option for intraoperative guidance and training, in both prostate (55% and 38.3%) and kidney cancer surgery (58.3% and 40%). HoloLens was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney), whereas printed models for patients counselling (66.7% for prostate and 61.7% for kidney). Fused deposition models were deemed as the best printing technology in representing kidney anatomy and renal tumor location (40%), while silicon (46.7%) and Polyjet (36.7%) models for prostate anatomy and cancer location. Finally, attendees demonstrated poor knowledge of 3D printing costs and production times. CONCLUSIONS Our study shows the perceptions of a heterogeneous surrogate of practising urologists about the role and potential applications of 3D imaging technologies in daily surgical practice.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy -
| | - Angela Pecoraro
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.,Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands
| | - Sabrina DE Cillis
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Departmet of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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Devlin CM, Fowler S, Biyani CS, Forster JA. Changes in UK renal oncological surgical practice from 2008 to 2017: implications for cancer service provision and surgical training. BJU Int 2021; 128:206-217. [PMID: 33249738 DOI: 10.1111/bju.15310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine and analyse the temporal changes in oncological nephrectomy practice and training opportunities using data obtained from the UK British Association of Urological Surgeons nephrectomy register from 2008 to 2017. PATIENT AND METHODS All nephrectomies within the dataset for this time period were analysed (n = 54 251). Cases were divided into radical nephrectomy (RN), partial nephrectomy (PN) and nephroureterectomy (NU). Simple nephrectomy, donor nephrectomy and benign PN were excluded. The annual frequencies for each oncological nephrectomy method, surgical approach, grade of surgeon, hospital caseload numbers and short-term surgical outcomes were determined. RESULTS Reported annual nephrectomy numbers increased by 2.5-fold in the 9-year time period. The number of hospitals performing nephrectomies decreased by 22%, however, more than 40% of centres performed more than 70 cases a year. There was a trend towards a decrease in overall length of hospital stay (9 vs 5 days; P < 0.01) and decreased transfusion rates. The proportion of minimally invasive procedures increased from 57% to 75%, with nephron-sparing rates increasing from 8.9% overall to 24.8%. With regard to surgical technique, robot-assisted surgery saw a mean annual increase of 222%. Overall, there was a 10% decrease in the proportion of PNs performed by trainee surgeons. CONCLUSIONS Renal surgery has changed considerably with regard to volume and also surgical approach, with rates of nephron-sparing surgery and minimally invasive surgery significantly increasing. Increasing hospital centralization and institutional experience, and a shift to robot-assisted surgery appear to have contributed to the observed improved patient outcomes. The increasing utilization of robot-assisted surgery has potential implications and challenges for the training of future urology surgeons.
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Affiliation(s)
- Conor M Devlin
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James A Forster
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
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Mari A, Tellini R, Ficarra V, Carini M, Minervini A. Reply to Nikolaos Grivas, Sanchia Goonewardene, Wouter Everaerts, Nikolaos Kalampokis's Letter to the Editor re: Andrea Mari, Riccardo Tellini, Francesco Porpiglia, et al. Perioperative and Mid-term Oncological and Functional Outcomes After Partial Nephrectomy for Complex (PADUA Score ≥10) Renal Tumors: A Prospective Multicenter Observational Study (the RECORD2, Project). Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2020.07.004. Eur Urol Focus 2020; 7:1212-1213. [PMID: 33384273 DOI: 10.1016/j.euf.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Vincenzo Ficarra
- Urologic Section, Gaetano Barresi Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
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Abstract
The use of robotic surgery in urology has grown exponentially in the past 2 decades, but robotic surgery training has lagged behind. Most graduating residents report a lack of comfort independently performing common robotic urologic surgeries, despite an abundance of available resources. There is a general consensus on the key components of a comprehensive robotics curriculum, and well-validated tools have been developed to assess trainee competency. However, no single curriculum has emerged as the gold standard on which individual programs can build their own robotics curricula.
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Affiliation(s)
- Robert S Wang
- Department of Urology, Michigan Medicine, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI 48109, USA
| | - Sapan N Ambani
- Department of Urology, Michigan Medicine, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI 48109, USA.
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The impact of intraoperative bleeding on the risk of chronic kidney disease after nephron-sparing surgery. World J Urol 2020; 39:2553-2558. [PMID: 33123741 DOI: 10.1007/s00345-020-03504-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The current literature regarding the effect of blood loss (eBL) after nephron-sparing surgery (NSS) on long-term renal function is scarce. We tested the effect of eBL on the risk of developing chronic kidney disease (CKD) after NSS. METHODS Within an institutional prospectively maintained database, we identified 215 patients treated with NSS for cT1N0M0 renal mass at one European high-volume center. Multivariable logistic regression models tested the effect of eBL on the risk of developing CKD, after accounting for surgical complexity, individual clinical characteristics, and surgical experience. Multivariable linear regression models identified predictors of eBL. RESULTS After a median follow-up of 36 months, 55 (25.6%) patients experienced CKD after surgery. At multivariable analyses, eBL independently predicted higher risk of CKD after NSS (odds ratio [OR]: 1.16; 95% confidence intervals [CI] 1.04-1.30; p < 0.01). Specifically, the relationship between eBL and probability of CKD emerged as nonlinear, with a plateau from 0 to 500 mL of eBL and an increase afterward. When multivariable linear regression analyses investigated predictors of eBL, hypertension (Est: 127, 95% CI 12-242; p = 0.03), clinical size (Est: 47, 95% CI 7-87; p = 0.02), and PADUA score (Est: 42; 95% CI 4-80 p = 0.03) achieved independent predictor status for higher intraoperative eBL. Conversely, surgical experience was associated with lower eBL (p = 0.01). CONCLUSIONS Intraoperative bleeding is independently associated with the risk of developing CKD after surgery, even after adjustment for well-known predictors of renal failure and tumor complexity. Hence, strategies aimed at maximally reducing such adverse events deserve special consideration.
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40
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Ghazi A, Melnyk R, Hung AJ, Collins J, Ertefaie A, Saba P, Gurung P, Frye T, Rashid H, Wu G, Mottrie A, Costello T, Dasgupta P, Joseph J. Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS). BJU Int 2020; 127:645-653. [PMID: 32936977 DOI: 10.1111/bju.15246] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To conduct a multi-institutional validation of a high-fidelity, perfused, inanimate, simulation platform for robot-assisted partial nephrectomy (RAPN) using incorporated clinically relevant objective metrics of simulation (CROMS), applying modern validity standards. MATERIALS AND METHODS Using a combination of three-dimensional (3D) printing and hydrogel casting, a RAPN model was developed from the computed tomography scan of a patient with a 4.2-cm, upper-pole renal tumour (RENAL nephrometry score 7×). 3D-printed casts designed from the patient's imaging were used to fabricate and register hydrogel (polyvinyl alcohol) components of the kidney, including the vascular and pelvicalyceal systems. After mechanical and anatomical verification of the kidney phantom, it was surrounded by other relevant hydrogel organs and placed in a laparoscopic trainer. Twenty-seven novice and 16 expert urologists, categorized according to caseload, from five academic institutions completed the simulation. RESULTS Clinically relevant objective metrics of simulators, operative complications, and objective performance ratings (Global Evaluative Assessment of Robotic Skills [GEARS]) were compared between groups using Wilcoxon rank-sum (continuous variables) and parametric chi-squared (categorical variables) tests. Pearson and point-biserial correlation coefficients were used to correlate GEARS scores to each CROMS variable. Post-simulation questionnaires were used to obtain subjective supplementation of realism ratings and training effectiveness. RESULTS Expert ratings demonstrated the model's superiority to other procedural simulations in replicating procedural steps, bleeding, tissue texture and appearance. A significant difference between groups was demonstrated in CROMS [console time (P < 0.001), warm ischaemia time (P < 0.001), estimated blood loss (P < 0.001)] and GEARS (P < 0.001). Six major intra-operative complications occurred only in novice simulations. GEARS scores highly correlated with the CROMS. CONCLUSIONS This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure-specific performance metrics.
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Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester, Rochester, NY, USA.,Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Andrew J Hung
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Justin Collins
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ashkan Ertefaie
- Department of Biostatistics, University of Rochester, NY, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Pratik Gurung
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Thomas Frye
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Guan Wu
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Alex Mottrie
- Urological Department, OLV Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Tony Costello
- Department Departments of Surgery and Urology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Medical Robotics Academy (AMRA), Melbourne, Vic., Australia
| | - Prokar Dasgupta
- Chair of Urology, Life Sciences and Medicine, King's College London, London, UK
| | - Jean Joseph
- Department of Urology, University of Rochester, Rochester, NY, USA
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Abstract
PURPOSE OF REVIEW The aim of this narrative review is to identify the currently available training programs in the field of robotic-assisted surgery. RECENT FINDINGS The lack of well trained robotic surgeons represents the main obstacle facing robotic surgery. This calls for development of structured robotic training programs in order to improve patient safety and outcomes. Structured curriculum should consist of theoretical training (e-learning, case observation), preclinical simulation-based training (virtual reality simulation, dry and wet lab), clinical modular training, and final evaluation. Tele-mentoring might reveal mandatory in future curricula development. To date, several training programs are currently available for robotic surgery. However, the majority lack of clinical modular training that consists of progressive, proficiency-based training through surgical steps with increasing levels of complexity. Moreover, many of these curricula lack validation. SUMMARY This recent literature analysis suggests that there is an urgent need to develop and validate new structured training curricula for robotic surgery. This allows to improve the skills of the surgeons and of their team and to prevent patients from being used as a training module optimizing their safety.
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Puliatti S, Mazzone E, Amato M, De Groote R, Mottrie A, Gallagher AG. Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model. Surg Endosc 2020; 35:4285-4294. [PMID: 32857241 DOI: 10.1007/s00464-020-07918-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery. OBJECTIVE To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model. DESIGN, SETTING AND PARTICIPANTS Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9-0.95). Novices took 18.5 min to complete the task and experts took 8.2 min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343). CONCLUSIONS We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.
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Affiliation(s)
- Stefano Puliatti
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Amato
- ORSI Academy, Melle, Belgium. .,Department of Urology, OLV, Aalst, Belgium. .,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Anthony G Gallagher
- ORSI Academy, Melle, Belgium.,Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK.,Faculty of Medicine, KU Leuven, Leuven, Belgium
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43
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Zeuschner P, Meyer I, Siemer S, Stoeckle M, Wagenpfeil G, Wagenpfeil S, Saar M, Janssen M. Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis. Ann Surg Oncol 2020; 28:1254-1261. [PMID: 32710272 PMCID: PMC7801306 DOI: 10.1245/s10434-020-08856-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/15/2020] [Indexed: 01/20/2023]
Abstract
Background Robot-assisted partial nephrectomy (RAPN) has become widely accepted, but its different underlying types of learning curves have not been comparatively analyzed to date. This study aimed to determine and compare the impact that the learning curve of the department, the console surgeon, and the bedside assistant as well as patient-related factors has on the perioperative outcomes of RAPN. Methods The study retrospectively analyzed 500 consecutive transperitoneal RAPNs (2007–2018) performed in a tertiary referral center by 7 surgeons and 37 bedside assistants. Patient characteristics and surgical data were obtained. Experience (EXP) was defined as the current number of RAPNs performed by the department, the surgeon, and the assistant. As the primary outcome, the impact of EXP and patient-related factors on perioperative outcomes were analyzed and compared. As the secondary outcome, a cutoff between “experienced” and “inexperienced” was defined. Correlation and regression analysis, receiver operating characteristic curve analysis, Fisher’s exact test, and the Mann–Whitney U test were performed, with p values lower than 0.05 denoting significance. Results The EXP of the department, the surgeon, and the assistant each has a major influence on perioperative outcome in RAPN irrespective of patient-related factors. Perioperative outcomes improve significantly with EXP greater than 100 for the department, EXP greater than 35 for the surgeon, and EXP greater than 15 for the assistant. Conclusions The perioperative results of RAPN are influenced by three different types of learning curves including those for the surgical department, the console surgeon, and the assistant. The influence of the bedside assistant clearly has been underestimated to date because it has a significant impact on the perioperative outcomes of RAPN. Electronic supplementary material The online version of this article (10.1245/s10434-020-08856-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Irmengard Meyer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stoeckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Martin Janssen
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany. .,Department of Urology and Pediatric Urology, University Hospital of Munster, Münster, Germany.
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44
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Bravi CA, Mari A, Larcher A, Amparore D, Antonelli A, Artibani W, Bertini R, Bove P, Brunocilla E, Da Pozzo L, di Maida F, Fiori C, Gallioli A, Gontero P, Li Marzi V, Longo N, Mirone V, Porpiglia F, Rocco B, Schiavina R, Schips L, Simeone C, Siracusano S, Tellini R, Terrone C, Trombetta C, Ficarra V, Carini M, Montorsi F, Capitanio U, Minervini A. Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project). Eur Urol Oncol 2020; 4:645-650. [PMID: 32646849 DOI: 10.1016/j.euo.2020.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ischemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative risk of AKI has never been investigated. OBJECTIVE To assess the effect of the interaction between the preoperative risk of AKI and ischemia time on the probability of AKI during PN. DESIGN, SETTING, AND PARTICIPANTS Data of 944 patients treated with on-clamp PN for cT1 renal tumors were extracted from the Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease (RECORD2) database, a prospective multicenter project. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We estimated the preoperative risk of AKI (defined according to the risk/injury/failure/loss/end-stage [RIFLE] criteria) according to age, baseline renal function, clinical stage, preoperative aspects and dimensions used for an anatomical (PADUA) score, and surgical approach. Classification and regression tree (CART) analysis identified patients at "high" and "low" risk of AKI. Finally, we plotted the probability of AKI over ischemia time stratified by the preoperative risk of AKI. RESULTS AND LIMITATIONS Overall, 235 (25%) patients experienced AKI after surgery. At multivariable analysis, older patients, those with more complex tumors, those with higher baseline function, and those treated with open surgery had an increased risk of AKI (all p ≤ 0.011). According to the first split at CART analysis, patients were categorized as those with "high" and "low" risk of AKI having a probability of >40% or <40%. For low-risk patients, the probability of AKI in case of <10 versus >20 min of ischemia was 13% versus 28% (absolute risk increase 15%). The risk of AKI for high-risk patients who had <10 versus >20 min of ischemia was 31% versus 77%. This corresponds to an absolute risk increase of 45%. Limitations include retrospective data analyses and lack of surgeons' prior experience. CONCLUSIONS Ischemia time during PN has different implications for patients with different health status. Clamp time seems less clinically relevant for patients in good conditions who may endure prolonged ischemia with a mild increase in the risk of AKI, whereas frail patients seem to be more vulnerable to ischemic damage even for short clamp time. For individualized intra- and postoperative management, duration of ischemia needs to be questioned in the context of the individual health status. PATIENT SUMMARY Functional sequelae related to ischemia time during partial nephrectomy depend on baseline health status. The correlation between the duration of ischemia and baseline health status should be taken into account toward individualized intra- and postoperative management.
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Affiliation(s)
- Carlo Andrea Bravi
- Division of Oncology/Unit of Urology, URI-Urological Research Institute, Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Unit of oncologic minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, URI-Urological Research Institute, Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- Department of Urology, Ospedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Roberto Bertini
- Division of Oncology/Unit of Urology, URI-Urological Research Institute, Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi Da Pozzo
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio di Maida
- Department of Urology, University of Florence, Unit of oncologic minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Andrea Gallioli
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Vincenzo Li Marzi
- Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicola Longo
- Department of Urology, University Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, University Federico II, Naples, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi Schips
- Department of Urology, SS Hospital. Annunziata, Chieti, Italy
| | - Claudio Simeone
- Department of Urology, Ospedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Unit of oncologic minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Carlo Terrone
- Department of Urology, University of Genova, Genova, Italy
| | - Carlo Trombetta
- U.C.O. Clinica Urologica, Università degli Studi di Trieste, Trieste, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology, Gaetano Barresi, Urologic Section, University of Messina, Messina, Italy
| | - Marco Carini
- Department of Urology, University of Florence, Unit of oncologic minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI-Urological Research Institute, Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Umberto Capitanio
- Division of Oncology/Unit of Urology, URI-Urological Research Institute, Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Unit of oncologic minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
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Beulens AJW, Dell'Oglio P, Kiss H, Brinkman WM, Larcher A, Mottrie A, Wagner C, van der Poel HG. Five Years of the CC-ERUS Fellowship: A Survey of the Experiences and Post-fellowship Work of the Fellows. EUR UROL SUPPL 2020; 19:45-47. [PMID: 34337454 PMCID: PMC8317813 DOI: 10.1016/j.euros.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/31/2023] Open
Affiliation(s)
- Alexander J W Beulens
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Netherlands Institute for Health Services, Utrecht, The Netherlands.,Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paulo Dell'Oglio
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Larcher
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | | | - Henk G van der Poel
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Ferriero M, Bove AM, Tuderti G, Anceschi U, Brassetti A, Costantini M, Mastroianni R, Guaglianone S, Gallucci M, Simone G. Impact of learning curve on perioperative outcomes of off-clamp minimally invasive partial nephrectomy: propensity score matched comparison of outcomes between training versus expert series. Minerva Urol Nephrol 2020; 73:564-571. [PMID: 32182230 DOI: 10.23736/s2724-6051.20.03673-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Off-clamp robotic partial nephrectomy (Off C-RPN) is a challenging technique, hard to teach since bleeding control is not easily reproducible in training settings. We compared perioperative outcomes of two propensity score matched (PSM) cohorts of patients undergone Off C-RPN by either a training or an expert surgeon in the same Institution. METHODS The prospectively maintained "renal cancer" database was queried for "off-clamp," "robotic," "partial nephrectomy" performed between January 2017 and June 2018. Achievement of main outcomes along the learning curve of training surgeon was assessed with logistic regression and Lowess analysis. A 1:1 PSM analysis generated two populations homogeneous for demographics, ASA score, tumor size, nephrometry score, baseline hemoglobin and estimated glomerular filtration rate (eGFR). Multiple tumors, and imperative indications were excluded. Categorical and continuous variables were compared by χ2 and t-test. RESULTS Overall, 111 were treated by the expert, 51 by the training surgeon, respectively. Training surgeon experienced a significant decrease of console time (P=0.01). Patients treated by the expert surgeon had significantly larger tumors, higher PADUA and ASA scores (all P≤0.04). After applying the PSM, two cohorts of 29 patients, homogeneous for all baseline demographic and clinical variables (all P≥0.34) were selected. Hilar clamping was never necessary. Hospital stay, hemoglobin and eGFR at discharge, complication and positive surgical margins rates were comparable between the two cohorts (all P≥0.15). CONCLUSIONS Our results proved that the impact of learning curve on outcomes of Off C-RPN is negligible after completion of a proper training in minimally invasive surgery.
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Affiliation(s)
| | - Alfredo Maria Bove
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Manuela Costantini
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
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Vanlander AE, Mazzone E, Collins JW, Mottrie AM, Rogiers XM, van der Poel HG, Van Herzeele I, Satava RM, Gallagher AG. Orsi Consensus Meeting on European Robotic Training (OCERT): Results from the First Multispecialty Consensus Meeting on Training in Robot-assisted Surgery. Eur Urol 2020; 78:713-716. [PMID: 32089358 DOI: 10.1016/j.eururo.2020.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/05/2020] [Indexed: 01/22/2023]
Abstract
To improve patient outcomes in robotic surgery, robotic training and education need to be modernised and augmented. The skills and performance levels of trainees need to be objectively assessed before they operate on real patients. The main goal of the first Orsi Consensus Meeting on European Robotic Training (OCERT) was to establish the opinions of experts from different scientific societies on standardised robotic training pathways and training methodology. After a 2-d consensus conference, 36 experts identified 23 key statements allotted to three themes: training standardisation pathways, validation metrics, and implementation prerequisites and certification. After two rounds of Delphi voting, consensus was obtained for 22 of 23 questions among these three categories. Participants agreed that societies should drive and support the implementation of benchmarked training using validated proficiency-based pathways. All courses should deliver an internationally agreed curriculum with performance standards, be accredited by universities/professional societies, and, trainees should receive a certificate approved by professional societies and/or universities after successful completion of the robotic training courses. This OCERT meeting established a basis for bringing surgical robotic training out of the operating room by seeking input and consensus across surgical specialties for an objective, validated, and standardised training programme with transparent, metric-based training outcomes. PATIENT SUMMARY: The Orsi Consensus Meeting on European Robotic Training (OCERT) is an international, multidisciplinary, Delphi-panel study of scientific societies and experts focused on training in robotic surgery. The panel achieved consensus that standardised international training pathways should be the basis for a structured, validated, replicable, and certified approach to implementation of robotic technology.
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Affiliation(s)
- Aude E Vanlander
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Elio Mazzone
- Orsi Academy, Melle, Belgium; Department of Urology, OLV, Aalst, Belgium; Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Justin W Collins
- Orsi Academy, Melle, Belgium; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Xavier M Rogiers
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | | | - Anthony G Gallagher
- Orsi Academy, Melle, Belgium; Faculty of Life and Health Sciences, Ulster University, Belfast, Northern Ireland, UK
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48
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Dell'Oglio P, Mazzone E, Lambert E, Vollemaere J, Goossens M, Larcher A, Van Der Jeugt J, Devos G, Poelaert F, Uvin P, Collins J, De Naeyer G, Schatteman P, D'Hondt F, Mottrie A. The Effect of Surgical Experience on Perioperative and Oncological Outcomes After Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Evidence from a Referral Centre with Extensive Experience in Robotic Surgery. Eur Urol Focus 2020; 7:352-358. [PMID: 32061537 DOI: 10.1016/j.euf.2020.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence on the learning curve for robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is limited. OBJECTIVE To assess the effect of surgical experience (SE) on perioperative and intermediate-term oncological outcomes in a large contemporary cohort of RARC patients after accounting for the impact of intersurgeon variability. DESIGN, SETTING, AND PARTICIPANTS The study cohort included 164 patients treated with RARC and ICUD by two surgeons between 2004 and 2017 at a single European referral centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For each patient, SE was defined as the total number of RARCs performed by each surgeon before the patient's operation. The relationship between SE and operative time (OT), lymph node yield (LNY), positive surgical margins (PSMs), Clavien-Dindo grade ≥2 30-d postoperative complication (CD≥2), and oncological outcomes (18-mo recurrence rate) was evaluated in multivariable linear and logistic regression models, clustering at a single-surgeon level. RESULTS AND LIMITATIONS After adjusting for case mix, SE was associated with shorter OT (p= 0.003), lower probability of postoperative CD≥2 rates (p= 0.01), and lower 18-mo recurrence rates (p= 0.002). Conversely, SE did not predict lower PSM rates (p= 0.3) and higher LNY (p= 0.4). The relationship between SE and OT was nonlinear, with a plateau observed after 50 cases. Conversely, the relationship between SE and CD≥2 and 18-mo recurrence was linear without reaching a plateau after 88 procedures. CONCLUSIONS SE affects perioperative and oncological outcomes after RARC with ICUD in a linear fashion, and its beneficial effect does not reach a plateau. Conversely, after 50 cases, no further improvement was observed for OT. PATIENT SUMMARY Robot-assisted radical cystectomy with intracorporeal urinary diversion is a complex surgical procedure with a relatively long learning curve.
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Affiliation(s)
- Paolo Dell'Oglio
- ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
| | - Elio Mazzone
- ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Edward Lambert
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | | | - Marijn Goossens
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Filip Poelaert
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Pieter Uvin
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | | | - Geert De Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Peter Schatteman
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | | | - Alexandre Mottrie
- ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
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Rassweiler J. Re: Validation of the Endoscopic Stone Treatment Step 1 (EST-s1): A Novel EAU Training and Assessment Tool for Basic Endoscopic Stone Treatment Skills-A Collaborative Work by ESU, ESUT and EULIS. Eur Urol 2020; 77:653-655. [PMID: 32037143 DOI: 10.1016/j.eururo.2020.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
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50
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Rosiello G, Capitanio U, Larcher A. Acute kidney injury after partial nephrectomy: transient or permanent kidney damage?-Impact on long-term renal function. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S317. [PMID: 32016035 DOI: 10.21037/atm.2019.09.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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