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Gadelkareem RA, Abdelgawad AM, Mohammed N, Zarzour MA, Khalil M, Reda A, Hammouda HM. Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies? World J Methodol 2024; 14:91626. [PMID: 38983660 PMCID: PMC11229866 DOI: 10.5662/wjm.v14.i2.91626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 06/13/2024] Open
Abstract
Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Amr Mostafa Abdelgawad
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nasreldin Mohammed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohammed Ali Zarzour
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Khalil
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Reda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hisham Mokhtar Hammouda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Goujon A, Kaulanjan K, Taha F, Gasmi A, Badet L, Bessede T, Boissier R, Boutin JM, Branchereau J, Culty T, Defortescu G, Drouin S, Kleinclauss F, Matillon X, Millet C, Prudhomme T, Sallusto F, Seizilles de Mazancourt E, Verhoest G, Timsit MO. Young urologists and kidney transplantation training: A survey designed by the French Transplantation Committee of the French Association of Urology (CTAFU) and the French Association of Urologists in training (AFUF). THE FRENCH JOURNAL OF UROLOGY 2024; 34:102611. [PMID: 38460937 DOI: 10.1016/j.fjurol.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/12/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE In France, kidney transplantations (KT) are mainly performed by urologist. Young urologists and residents are involved in this activity mostly performed in emergency. How do they feel about KT training? Is KT an attractive part of the urologist activity? METHODS This survey has been designed in the form of a questionnaire by the French Committee of Kidney Transplantation (CTAFU) and the French Association of Urologists in training (AFUF). It has been sent by e-mail to all the AFUF members. Interest in KT and performance of the training were evaluated. RESULTS In total, 126 members filed the form. Among the residents, 51.5% feel secure to perform KT at the end of their residency. KT is considered as an interesting surgery for 92.1% of the participants: 76.5% are willing to get involved in KT during their residency/fellowship. Among the participants, 44% are willing to continue a long-term involvement. Among the residents, 65.9% consider their practical training insufficient: 56.8% have been supervised for a KT performance during their residency and 86% declare a lack of practical training and had a patient-based learning. Among the residents, 92.1% declare an insufficient theorical training. Among the residents, 33.3% say the schedules of transplantation limit their interest in KT. Among the participants, 34.4% receive a transplant bonus in addition to the usual on-call salary. CONCLUSION Young urologists wish to continue their involvement in KT activity, but improved theoretical and practical training are essential. In addition, the conditions under which this activity is performed and remunerated are a matter of concern. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Anna Goujon
- Department of Urology, Rennes University Hospital, Rennes, France; Department of Nephrology, Rennes University Hospital, Rennes, France.
| | | | - Fayek Taha
- Department of Urology Reims University Hospital, Reims, France
| | - Anis Gasmi
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Lionel Badet
- Department of Urology Hospices Civils de Lyon, Lyon, France
| | - Thomas Bessede
- Department of Urology Kremlin-Bicêtre Hospital, Paris, France
| | - Romain Boissier
- Department of Urology La Conception Hospital, Marseille, France
| | - Jean-Michel Boutin
- Department of Urology, Trousseau-Chambray University Hospital, Tours, France
| | | | - Thibaut Culty
- Department of Urology, Angers University Hospital, Angers, France
| | | | - Sarah Drouin
- Department of Urology La Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Clementine Millet
- Department of Urology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Thomas Prudhomme
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Federico Sallusto
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - Gegory Verhoest
- Department of Urology, Rennes University Hospital, Rennes, France
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Remschmidt B, Rieder M, Gsaxner C, Gaessler J, Payer M, Wallner J. Augmented Reality-Guided Apicoectomy Based on Maxillofacial CBCT Scans. Diagnostics (Basel) 2023; 13:3037. [PMID: 37835780 PMCID: PMC10572956 DOI: 10.3390/diagnostics13193037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Implementation of augmented reality (AR) image guidance systems using preoperative cone beam computed tomography (CBCT) scans in apicoectomies promises to help surgeons overcome iatrogenic complications associated with this procedure. This study aims to evaluate the intraoperative feasibility and usability of HoloLens 2, an established AR image guidance device, in the context of apicoectomies. Three experienced surgeons carried out four AR-guided apicoectomies each on human cadaver head specimens. Preparation and operating times of each procedure, as well as the subjective usability of HoloLens for AR image guidance in apicoectomies using the System Usability Scale (SUS), were measured. In total, twelve AR-guided apicoectomies on six human cadaver head specimens were performed (n = 12). The average preparation time amounted to 162 (±34) s. The surgical procedure itself took on average 9 (±2) min. There was no statistically significant difference between the three surgeons. Quantification of the usability of HoloLens revealed a mean SUS score of 80.4 (±6.8), indicating an "excellent" usability level. In conclusion, this study implies the suitability, practicality, and simplicity of AR image guidance systems such as the HoloLens in apicoectomies and advocates their routine implementation.
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Affiliation(s)
- Bernhard Remschmidt
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Marcus Rieder
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Christina Gsaxner
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria
| | - Jan Gaessler
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Juergen Wallner
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
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Chytas D, Gyftopoulos K. Use of Thiel-embalmed cadavers in urology training and their ability to retain real-life anatomy: a systematic review. ANZ J Surg 2023; 93:1787-1792. [PMID: 36978262 DOI: 10.1111/ans.18436] [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: 01/14/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Thiel-embalmed cadavers (TeCs) have been proposed as an alternative and probably safer method of surgical training, compared to formalin-embalmed cadavers. We aimed to perform a systematic review on the use of TeCs in urology training and their ability to represent real-life anatomy. METHODS PubMed, SCOPUS and Cochrane databases were searched for articles with purpose to explore the use of TeCs in urology training, without date restrictions, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From each paper, we evaluated the type of procedure, the number of participants, the type of study, the educational outcomes and their level, according to Kirkpatrick hierarchy. RESULTS Of the 225 records initially retrieved, eight articles were eventually included. All studies evaluated participants' perceptions about the procedure. Overall, urology trainees and specialists have positively commented on the educational value of TeCs, which have been also found able to adequately mimic real-life conditions. In all the eight studies, trainees stated that tissue quality of TeCs was adequately realistic and considered TeCs as a useful surgical training tool. CONCLUSION Although the use of TeCs in urology training has so far been limited, their value as a surgical training tool has been positively perceived. These outcomes suggest that TeCs may also enhance urology trainees' surgical skills and may encourage their implementation as a simulation tool in urology training.
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Affiliation(s)
- Dimitrios Chytas
- Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
- European University Cyprus, Nicosia, Cyprus
| | - Kostis Gyftopoulos
- Department of Anatomy, School of Medicine, University of Patras, Patras, Greece
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Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
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Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
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Patnaik R, Khan MTA, Oh T, Yamaguchi S, Fritze DM. Technical skills simulation in transplant surgery: a systematic review. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:42. [PMID: 38013707 PMCID: PMC9483372 DOI: 10.1007/s44186-022-00028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2023]
Abstract
Purpose Transplant surgery is a demanding field in which the technical skills of the surgeon correlates with patient outcomes. As such, there is potential for simulation-based training to play an important role in technical skill acquisition. This study provides a systematic assessment of the current literature regarding the use of simulation to improve surgeon technical skills in transplantation. Methods Data were collected by performing an electronic search of the PubMed and Scopus database for articles describing simulation in transplant surgery. The abstracts were screened using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Three reviewers analyzed 172 abstracts and agreed upon articles that met the inclusion criteria for the systematic review. Results Simulators can be categorized into virtual reality simulators, cadaveric models, animal models (animate or inanimate) and synthetic physical models. No virtual reality simulators in transplant surgery are described in the literature. Three cadaveric models, seven animal models and eight synthetic physical models specific to transplant surgery are described. A total of 18 publications focusing on technical skills simulation in kidney, liver, lung, pancreas, and cardiac transplantation were found with the majority focusing on kidney transplantation. Conclusions This systematic review identifies currently reported simulation models in transplant surgery. This will serve as a reference for general surgery and transplant surgery professionals interested in using simulation to enhance their technical skills.
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Affiliation(s)
- R. Patnaik
- Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - M. T. A. Khan
- Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - T. Oh
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX USA
| | - S. Yamaguchi
- Department of Transplant Surgery, University of Texas Health San Antonio, San Antonio, TX USA
| | - D. M. Fritze
- Department of Transplant Surgery, University of Texas Health San Antonio, San Antonio, TX USA
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Patnaik R, Khan MT, Yamaguchi S, Fritze DM. Building a Low-Cost and Low-Fidelity Kidney Transplant Model: A Technical Report on the San Antonio Kidney Transplant Model. Cureus 2022; 14:e23883. [PMID: 35530913 PMCID: PMC9075688 DOI: 10.7759/cureus.23883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/22/2022] Open
Abstract
One of the most challenging aspects of the kidney transplant operation is performing vascular anastomoses in the confines and depths of the iliac fossa. General surgery residents need to be adequately trained in this skill to maximize their intraoperative experience during their transplant surgery rotation. While several kidney transplant models have been developed, they are limited in their ability to simulate the challenges of performing anastomoses at varying depths and in confined spaces. Furthermore, they may be expensive or require specialized equipment, such as three-dimensional printers, to build. In this technical report, we describe how to build a low-fidelity, low-cost, and portable kidney transplant model capable of simulating vascular anastomoses at varying depths. Our model can be easily replicated for less than 30 USD using materials available in local stores. It uses inexpensive and reusable parts, allowing trainees a high volume of repetitions.
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Affiliation(s)
- Ronit Patnaik
- General Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Mustafa T Khan
- General Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Seiji Yamaguchi
- Transplant Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Danielle M Fritze
- Transplant Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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Mitsugashira H, Tokodai K, Nakanishi W, Fujio A, Kashiwadate T, Miyazawa K, Sasaki K, Miyagi S, Owada Y, Unno M, Kamei T. Usefulness of Thiel-Embalmed Cadavers for Training in Organ Procurement. Transplant Proc 2022; 54:230-232. [PMID: 35031119 DOI: 10.1016/j.transproceed.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The number of brain-dead donors has been increasing; however, the opportunity for young surgeons to experience deceased donor surgeries is extremely limited, especially in many Asian countries including Japan. Deceased donor surgeries require unique surgical skills and knowledge; however, it is difficult to provide on-the-job guidance and education. Therefore, cadaver training is meaningful and suitable for the training of deceased donor surgeries. Thiel's embalming method (TEM) provides natural coloration, flexibility, and tissue plasticity, and is widely used for cadaver surgical training. In this study, we evaluated the usefulness of Thiel's embalmed cadaver training for organ procurement surgery. MATERIAL AND METHODS Each trainee performed hepatectomy, pancreatectomy, and nephrectomy using conventional open techniques. Faculty experts of transplantation surgery and organ procurement took attendees through surgical steps. After the procedure, all participants were asked to complete a voluntary, anonymous survey, consisting of a 10-point satisfaction scale, to evaluate their perceptions of the training. RESULTS A total of 33 gastrointestinal surgeons participated in the training program for procuring the liver, pancreas, and kidneys. In the questionnaire administered to the participants, the evaluation was generally satisfactory, with an average of 9.1 points on the 10-point scales. Some participants expressed that Thiel-embalmed cadavers are more suitable for training on organ procurement compared with animals used in wet-lab training. CONCLUSION We conclude that organ procurement training in human cadavers preserved by TEM is useful and suitable for practicing deceased donor organ procurement, especially in countries where deceased donors are not common, as in Japan.
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Affiliation(s)
| | | | | | - Atsushi Fujio
- Department of Surgery, Tohoku University, Sendai, Japan
| | | | - Koji Miyazawa
- Department of Surgery, Tohoku University, Sendai, Japan
| | - Kengo Sasaki
- Department of Surgery, Tohoku University, Sendai, Japan
| | | | - Yuji Owada
- Department of Organ Anatomy, Tohoku University, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University, Sendai, Japan
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Expect the unexpected: The course of the inferior alveolar artery - Preliminary results and clinical implications. Ann Anat 2021; 240:151867. [PMID: 34823013 DOI: 10.1016/j.aanat.2021.151867] [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: 07/22/2021] [Revised: 10/31/2021] [Accepted: 11/15/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The anatomical position of the inferior alveolar artery (IAA) within the mandibular canal and in relation to the substructures of the neurovascular mandibular bundle has been sparsely described to date. More detailed information on the exact IAA position would be beneficial for both dental and maxillofacial surgical procedures to minimize complications such as bleeding, nerve compression hematoma, and sensory deficiency. MATERIAL AND METHODS In 31 Thiel-preserved and fresh-frozen cadaver hemimandibles the position of the IAA in relation to the structures of the inferior alveolar neurovascular bundle and the mandible borders was analyzed anatomically and histologically. RESULTS In 77.4% of the cases, rotation of the IAA around the mental nerve was apparent, resulting in a typical site-dependent IAA position. While the IAA was situated buccally within the pterygomandibular space, buccal-inferior in the mandibular foramen, superior in the molar region, and lingually in the premolar region. In 12.9% of the cases, a persistent lingual position of the IAA was observed for the entire mandibular canal. In one case, an additional mandibular canal and an accessory IAA were identified. DISCUSSION This study provides new and encompassing information on the complete course and position of the IAA. This course is of practical use for oral implantology and various surgical procedures in dental- and maxillofacial surgery. Variations in the typical IAA course and site-dependent positional changes may be referred to as mandible growth and functional adaption to occlusion anomalies. This report helps enhance the morphological and functional understanding of IAA relationship during mandible development.
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Melkonian V, Huy T, Varma CR, Nazzal M, Randall HB, Nguyen MTJ. The Creation of a Novel Low-Cost Bench-Top Kidney Transplant Surgery Simulator and a Survey on Its Fidelity and Educational Utility. Cureus 2020; 12:e11427. [PMID: 33312823 PMCID: PMC7727770 DOI: 10.7759/cureus.11427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Resident inexperience during time-sensitive vascular anastomoses of a kidney transplant can negatively impact outcomes. In light of this, we created a low-cost bench-top kidney transplant surgery simulator to help residents practice vascular anastomoses. Methods We searched for inexpensive materials to design an iliac fossa and kidney allograft. Eighteen residents with real-life kidney transplant experience trialed the simulator and scored its fidelity and educational utility on a 0-100 visual analog scale (VAS) survey. Results A 35.9 x 19.4 x 12.4 cm plastic box mimicked the iliac fossa. Hooks attached to the box's sidewall held under tension 1.27 and 0.64 cm diameter Penrose drains to replicate the external iliac vein and artery. A modified kidney-shaped stress ball with 1.27 x 4, 0.64 x 4, and 0.64 x 15 cm Penrose drains replicated a kidney allograft with its vein, artery, and ureter, respectively. Residents performed and assisted in vascular anastomoses on the simulator. The iliac fossa and allograft cost $20.20 and each practice run cost $7.20. Residents thought that the simulator was less difficult than real-life procedure, had acceptable fidelity levels, and they highly rated its educational utility. Conclusion Our novel low-cost bench-top kidney transplant surgery simulator focusing on vascular anastomoses received positive educational feedback from residents.
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Affiliation(s)
- Vatche Melkonian
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Tess Huy
- Surgery, University of California Los Angeles, Los Angeles, USA
| | - Chintalapati R Varma
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Mustafa Nazzal
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Henry B Randall
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Minh-Tri J Nguyen
- Transplant Surgery, Transplant Institute, Loma Linda University Medical Center, Loma Linda, USA
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Saba P, Belfast E, Melnyk R, Patel A, Kashyap R, Ghazi A. Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies. J Endourol 2020; 34:1088-1094. [DOI: 10.1089/end.2020.0441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Belfast
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Ankit Patel
- Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
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Mantica G, Leonardi R, Pini G, Esperto F, Proietti S, van Deventer H, Giusti G, Gaboardi F, van der Merwe A, Terrone C. The current use of human cadaveric models in urology: a systematic review. MINERVA UROL NEFROL 2020; 72:313-320. [DOI: 10.23736/s0393-2249.19.03558-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Establishment and evaluation of a training course in advanced laparoscopic surgery based on human body donors embalmed by ethanol-glycerol-lysoformin fixation. Surg Endosc 2020; 35:1385-1394. [PMID: 32444969 PMCID: PMC7886762 DOI: 10.1007/s00464-020-07523-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023]
Abstract
Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.
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Al-Jabir A, Aydin A, Al-Jabir H, Khan MS, Dasgupta P, Ahmed K. Current status of wet lab and cadaveric simulation in urological training: A systematic review. Can Urol Assoc J 2020; 14:E594-E600. [PMID: 32520706 DOI: 10.5489/cuaj.6520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We undertook a systematic review of the use of wet lab (animal and cadaveric) simulation models in urological training, with an aim to establishing a level of evidence (LoE) for studies and level of recommendation (LoR) for models, as well as evaluating types of validation. METHODS Medline, EMBASE, and Cochrane databases were searched for English-language studies using search terms including a combination of "surgery," "surgical training," and "medical education." These results were combined with "wet lab," "animal model," "cadaveric," and "in-vivo." Studies were then assigned a LoE and LoR if appropriate as per the education-modified Oxford Centre for Evidence-Based Medicine classification. RESULTS A total of 43 articles met the inclusion criteria. There was a mean of 23.1 (±19.2) participants per study with a median of 20. Overall, the studies were largely of low quality, with 90.7% of studies being lower than LoE 2a (n=26 for LoE 2b and n=13 for LoE 3). The majority (72.1%, n=31) of studies were in animal models and 27.9% (n=12) were in cadaveric models. CONCLUSIONS Simulation in urological education is becoming more prevalent in the literature, however, there is a focus on animal rather than cadaveric simulation, possibly due to cost and ethical considerations. Studies are also predominately of a low LoE; higher LoEs, especially randomized controlled studies, are needed.
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Affiliation(s)
- Ahmed Al-Jabir
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Hussain Al-Jabir
- William Harvey Research Institute, Barts and The London School of Medicine School of Medicine and Dentistry, London, United Kingdom
| | - M Shamim Khan
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Kozan AA, Chan LH, Biyani CS. Current Status of Simulation Training in Urology: A Non-Systematic Review. Res Rep Urol 2020; 12:111-128. [PMID: 32232016 PMCID: PMC7085342 DOI: 10.2147/rru.s237808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Simulation has emerged as an effective solution to increasing modern constraints in surgical training. It is recognized that a larger proportion of surgical complications occur during the surgeon's initial learning curve. The simulation takes the learning curve out of the operating theatre and facilitates training in a safe and pressure-free environment whilst focusing on patient safety. The cost of simulation is not insignificant and requires commitment in funding, human resources and logistics. It is therefore important for trainers to have evidence when selecting various simulators or devices. Our non-systematic review aims to provide a comprehensive up-to-date picture on urology simulators and the evidence for their validity. It also discusses emerging technologies and future directions. Urologists should embed evidence-based simulation in training programs to shorten learning curves while maintaining patient safety and work should be directed toward a validated and agreed curriculum.
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Affiliation(s)
- Andrei Adrian Kozan
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Luke Huiming Chan
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Chandra Shekhar Biyani
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
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Coloma L, Cabello R, González C, Quicios C, Bueno G, García JV, Arribas AB, Clascá F. Cadaveric Models for Renal Transplant Surgery Education: a Comprehensive Review. Curr Urol Rep 2020; 21:10. [PMID: 32166557 DOI: 10.1007/s11934-020-0961-x] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To evaluate the utility of cadaveric models for kidney transplant (KT) surgery training. RECENT FINDINGS Medline® and PubMed® databases were searched for English and Spanish language articles published describing different learning models used in KT formation. We evaluated the use of cadavers preserved by Thiel's embalming method (TEM) as KT simulation models. Students were divided in groups of 4 people: four trainees mentored by an expert in KT surgery. Among the trainees were surgical residents and low-experience surgeons. A total of 39 TEM preserved bodies were used, of which 75 viable renal grafts were obtained. In each cadaver, two complete transplantation processes were performed, each consisting of en bloc nephrectomy with the trunk of aorta and inferior vena cava, bench surgery and perfusion with saline of the organ, and KT surgery. As with any surgical procedure, learning KT surgery is a stepwise process that requires years of dedication. The models available for the surgical simulation of KT surgery allow to practice and achieve dexterity in performing the procedure in a safe and reproducible way. Training on TEM-preserved corpses offers a highly realistic model for the surgical simulation of KT surgery.
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Affiliation(s)
- Lidia Coloma
- Urology Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain
| | - Ramiro Cabello
- Urology Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain.
| | - Carmen González
- Urology Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina Quicios
- Urology Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain
| | - Gonzalo Bueno
- Urology Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan Vicente García
- Urology Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Begoña Arribas
- Vascular Surgery Department, Hospital Universitario Fundación Jiménez Díaz/Universidad Autónoma de Madrid, Madrid, Spain
| | - Francisco Clascá
- Anatomy, Histology and Neuroscience Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Selzer DJ. Overview of Simulation in Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Educational training in laparoscopic gynecological surgery based on ethanol-glycerol-lysoformin-preserved body donors. Ann Anat 2018; 221:157-164. [PMID: 30312766 DOI: 10.1016/j.aanat.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Educational training of laparoscopic skills performed on body donors is considered the gold standard prior to surgery in living patients. Appropriate, safe, and feasible fixation of body donors, reflecting true-to-life conditions of tissues, is an essential prerequisite for training workshops. MATERIALS AND METHODS Here we describe and evaluate a modified ethanol-glycerol-lysoformin-based fixation technique. Body donors were fixed by perfusion (70% ethanol, 30% glycerol, 0.3% lysoformin; ca. 20l) via femoral artery and stored in a humid atmosphere (1% thymol) at 4°C. Technical equipment included a mobile operating table, endoscopy system with gas insufflation, suction/irrigation pump, standard and electrosurgical instruments. The tissue properties of ethanol-glycerol-lysoformin-fixed body donors and their suitability for laparoscopic surgery were tested and compared to the in vivo situation. RESULTS Modified ethanol-glycerol-lysoformin fixation was a simple, cost-efficient and hazard-free procedure, resulting in near-to-life tissue conditions regarding consistency and flexibility, with moderate discoloration and greater viscosity of organs. Key laparoscopic procedures (trocar handling, pneumoperitoneum, blunt/sharp dissection, partial/total removal of organs, bi- or monopolar electrosurgery, suturing techniques) could be performed without difficulty. Multiple reuse of body donors was feasible over one year. Compared to the in vivo situation, the investigation of body donors required a greater degree of gas insufflation and more energy for electrosurgery. CONCLUSIONS Modified ethanol-glycerol-lysoformin fixation applied to body donors permitted laparoscopic surgery in a realistic and practical manner. Due to its logistic advantages, this technique provides appropriate conditions to train laparoscopic skills and implement novel minimally invasive approaches.
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Bruneder S, Wallner J, Weiglein A, Kmečová Ĺ, Egger J, Pilsl U, Zemann W. Anatomy of the Le Fort I segment: Are arterial variations a potential risk factor for avascular bone necrosis in Le Fort I osteotomies? J Craniomaxillofac Surg 2018; 46:1285-1295. [DOI: 10.1016/j.jcms.2018.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/04/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022] Open
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He B, Mou L, De Roo R, Musk GC, Hamdorf JM. Evaluation of Three-Dimensional Versus Conventional Laparoscopy for Kidney Transplant Procedures in a Human Cadaveric Model. EXP CLIN TRANSPLANT 2017; 15:497-503. [PMID: 28447928 DOI: 10.6002/ect.2016.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There are increased reports that kidney transplant can be performed by laparoscopic surgery. The further development of this technique could revolutionize human kidney transplant surgery. However, laparoscopic kidney transplant demands a high level of skill for vascular anastomoses. The emerging technology of the three-dimensional, high-definition laparoscopic system may facilitate the application of this technique. Therefore, in this study, we evaluated this system in performing kidney transplant surgery versus the two-dimensional laparoscopic system. MATERIALS AND METHODS Four fresh-frozen human cadavers were used in this study, with 2 for the 3-dimensional and 2 for the 2-dimensional system. Kidneys were retrieved by using the retroperitoneoscopic technique for living donor nephrectomy from the same cadaver. The kidney graft was transplanted at the right iliac fossa using a laparoscopic technique by extraperitoneal approach. The procedure was recorded, and the vessel anastomotic time was analyzed. RESULTS Kidney transplant procedures were conducted successfully in the 3-dimensional, high-definition and the 2-dimensional groups. We recorded no significant differences in terms of vessel anastomotic time between the 2 groups. The total surgery time was shorter in the 3-dimensional, high-definition group than in the 2-dimensional group (P = .02). CONCLUSIONS This pilot study reinforces that kidney transplant with either the 3-dimensional, high-definition or 2-dimensional laparoscopy is feasible in a human cadaveric model. The operation was the same as open kidney transplant, but the procedure was performed by a laparoscopic approach with a smaller incision.
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Affiliation(s)
- Bulang He
- From the Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, Australia; and the School of Surgery, The University of Western Australia, Perth, Australia
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Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment: A new approach? J Craniomaxillofac Surg 2017; 45:526-539. [PMID: 28256384 DOI: 10.1016/j.jcms.2017.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/18/2016] [Accepted: 01/20/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Fractures of the mandibular angle are a common type of facial skull fracture. Although operative treatment includes a wide range of fixation techniques, a definite gold standard method has yet to be established. Headless, cannulated Herbert screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation. MATERIALS AND METHODS In a prospective, double-randomised, controlled, parallel-group - designed, in vitro trial, the biomechanical behaviour of the Herbert bone screw system was compared to that of a conventional locking plate system in 40 mandibular angle fractures of human mandible cadaver phantoms. RESULTS The mean stress values were 250 (±68.0) N in the plate subgroup and 200 (±61.0) N in the screw subgroup. The respective mean strain values were 7.90 (±2.7) mm and 6.90 (±2.2) mm, and the respective mean stiffness were values 1.10 (±0.61) N/m and 0.78 (±0.40) N/m. The differences in the results obtained using the two treatments were not significant (p = 0.55). CONCLUSIONS The biomechanical behaviour of the two fixation systems within the tested loads did not significantly differ with respect to postoperative parameters clinically relevant in osteosynthesis. Both systems met the mandibular angle assessment criterion, which is considered to be sufficient for clinical use. The results indicate the potential clinical utility of these two systems, and recommend further testing.
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Aydin A, Shafi AM, Shamim Khan M, Dasgupta P, Ahmed K. Current Status of Simulation and Training Models in Urological Surgery: A Systematic Review. J Urol 2016; 196:312-20. [DOI: 10.1016/j.juro.2016.01.131] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Ahmed M.A. Shafi
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
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