1
|
Wu SC, Swanton AR, Jones JM, Gross MS. New findings regarding the influence of assistants on surgical outcomes in penile prosthesis implantation. Int J Impot Res 2023; 35:736-740. [PMID: 36209303 DOI: 10.1038/s41443-022-00624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation is the definitive treatment for refractory erectile dysfunction, yet exposure to this procedure during training of urology residents is often limited. To assess the effects of resident participation in penile prosthesis surgery, we compared surgical outcomes in a retrospective case series of 253 penile prosthesis surgeries by a single surgeon at the same institution between 2017 and 2020 with the assistance of either a registered nurse first assistant (RNFA) or a resident. Pertinent patient characteristics and surgical complications including device complications, surgical site infection, postoperative bleeding, iatrogenic injury, cardiovascular events, pulmonary events, and urinary retention were documented. Measured outcomes included operative time, Emergency Room (ER) visits, unplanned postoperative visits, pain medication refills, and surgical complications. Compared to RFNAs, resident-assisted penile prosthesis surgery was associated with significant increase in mean operative time (71.4 min vs. 87.9 min, p < 0.01) and postoperative ER visits (3.0% vs. 10.6%, p = 0.03) but not surgical complications (19.7% vs. 20.8%, OR 1.03, 95% CI [0.46 -2.30]) or other measured outcomes. Compared to a dedicated RFNA, Resident assistance increased operative time by approximately 17 min, but did not increase post-operative surgical complications, supporting the notion that resident assistance in these procedures may be appropriate as an integral part of training.
Collapse
Affiliation(s)
- Shuo-Chieh Wu
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Amanda R Swanton
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James M Jones
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| |
Collapse
|
2
|
Facility-level analysis of robot utilization across disciplines in the National Cancer Database. J Robot Surg 2018; 13:293-299. [PMID: 30062641 DOI: 10.1007/s11701-018-0855-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/23/2018] [Indexed: 01/23/2023]
Abstract
To evaluate trends in contemporary robotic surgery across multiple organ sites as they relate to robotic prostatectomy volume. We queried the National Cancer Database for patients who underwent surgery from 2010 to 2013 for prostate, kidney, bladder, corpus uteri, uterus, cervix, colon, sigmoid, rectum, lung and bronchus. The trend between volumes of robotic surgery for each organ site was analyzed using the Cochran-Armitage test. Multivariable models were then created to determine independent predictors of robotic surgery within each organ site by calculating the odds ratio with 95% CI. Among the 566,399 surgical cases analyzed, 35.1% were performed using robot assistance. Institutions whose robotic prostatectomy volume was in the top 75 percentile compared to the bottom 25 percentile performed a larger percentage of robotic surgery on the following sites: kidney 32.6 vs. 28.8%, bladder 23.6 vs. 18.6%, uterus 52.5 vs. 47.7%, cervix 43.5 vs. 39.2%, colon 3.2 vs. 2.9%, rectum 10.7 vs. 8.9%, and lung 7.3 vs. 6.8% (all p < 0.0001). It appears that increased trends toward robotic surgery in urology have lead to increased robotic utilization within other surgical fields. Future analysis in benign utilizations of robotic surgery as well as outcome data comparing robotic to open approaches are needed to better understand the ever-evolving nature of minimally invasive surgery within the United States.
Collapse
|
3
|
Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes? Urol Oncol 2017; 35:227-233. [PMID: 28089074 DOI: 10.1016/j.urolonc.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Partial nephrectomy (PN) represents the treatment of choice for localized renal tumor<7cm. Minimally invasive approaches are considered standard of care in many institutions. Maintaining acceptable warm ischemic time (WIT) while teaching robotic PN (RPN) remains challenging. The goal of the present study was to assess the effect of teaching RPN on WIT and renal function in patients undergoing RPN. METHODS Patients undergoing RPN for cT1-T2 renal tumors were included. RENAL nephrometry score was used to adjust for tumor complexity. Glomerular filtration rates (GFR) were determined preoperatively, at day 2 and at ≥3-month follow-up. Patients in whom the attending surgeon (staff) performed tumorectomy and renorraphy were compared with those in whom the fellow performed these steps. Primary outcomes were WIT and GFR decrease at follow-up visit. Morbidity and margin positivity represented secondary outcomes. RESULTS Overall, 69 patients (46 "staff" vs. 23 "fellow") were included. Patient׳s characteristics did not differ significantly between the 2 groups. In particular, RENAL score and preoperative GFR were similar between both groups. Mean WIT was 22±9 in the staff and 24±7 in the fellow group (P = 0.09). At follow-up, a GFR reduction of 9% was observed in the staff group vs. 13% in the fellow group (P = 0.38). Complication rates (13% vs. 17%, P = 0.63) and positive margins (9% vs. 4%, P = 0.47) did not differ significantly between staff and fellow. CONCLUSIONS In our experience, teaching RPN with a strict supervision and stepwise standardized procedure was oncologically and functionally safe after 3 to 6 months of follow-up.
Collapse
|
4
|
O'Kane D, Papa N, Lawrentschuk N, Syme R, Giles G, Bolton D. Supervisor volume affects oncological outcomes of trainees performing open radical prostatectomy. ANZ J Surg 2015; 86:249-54. [DOI: 10.1111/ans.13112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Dermot O'Kane
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Urology Department; Austin Hospital; Melbourne Victoria Australia
| | - Nathan Papa
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Cancer Council Victoria; Cancer Epidemiology Centre; Melbourne Victoria Australia
- Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Nathan Lawrentschuk
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Urology Department; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Olivia Newton-John Cancer Research Institute; Melbourne Victoria Australia
- Urology Unit; Epworth Freemasons Hospital; Melbourne Victoria Australia
| | - Rodney Syme
- Urology Unit; Epworth Freemasons Hospital; Melbourne Victoria Australia
| | - Graham Giles
- Cancer Council Victoria; Cancer Epidemiology Centre; Melbourne Victoria Australia
- Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Damien Bolton
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Urology Department; Austin Hospital; Melbourne Victoria Australia
| |
Collapse
|
5
|
The short term feasibility of abdominoperineal resection with prostatectomy for locally advanced rectal cancer: open and laparoscopic cases report. Int Cancer Conf J 2015; 5:20-25. [PMID: 31149417 DOI: 10.1007/s13691-015-0218-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/29/2015] [Indexed: 01/04/2023] Open
Abstract
Total pelvic exenteration is often selected for advanced rectal cancer with prostatic invasion. The aim of this study was to evaluate the short term feasibility of the abdominoperineal resection with prostatectomy for locally advanced rectal cancer. We performed abdominoperineal resection with prostatectomy for 3 patients with locally advanced rectal cancer, including 2 patients by totally laparoscopic procedure. Patients' background, intra- and postoperative factors and short-term prognosis were evaluated. All patients underwent complete resection of primary tumor with negative surgical margins. We could perform the surgery by both open and laparoscopic procedure in collaboration with urologist. There was no operation related mortality. One patient who was treated by open procedure had urinary anastomotic leakage. No patient had recurrenced, but one patient died of other disease. Our experience suggests that open or laparoscopic abdominoperineal resection with prostatectomy could be an alternative to total pelvic exenteration for the patients with rectal cancer invading the prostate. The collaboration with the urologist would be important to perform quality-controlled surgery.
Collapse
|
6
|
Ruhotina N, Dagenais J, Gandaglia G, Sood A, Abdollah F, Chang SL, Leow JJ, Olugbade K, Rai A, Sammon JD, Schmid M, Varda B, Zorn KC, Menon M, Kibel AS, Trinh QD. The impact of resident involvement in minimally-invasive urologic oncology procedures. Can Urol Assoc J 2014; 8:334-40. [PMID: 25408800 DOI: 10.5489/cuaj.2170] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. METHODS Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005-2011), we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. RESULTS A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic). CONCLUSIONS Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.
Collapse
Affiliation(s)
- Nedim Ruhotina
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julien Dagenais
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - Akshay Sood
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; ; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Steven L Chang
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Kola Olugbade
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Arun Rai
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jesse D Sammon
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; ; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Marianne Schmid
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Briony Varda
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kevin C Zorn
- Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - Mani Menon
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Adam S Kibel
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
7
|
Huber J, Groeben C, Wirth MP. [Removal of the primary tumor in hematogenous metastatic tumor disease: reasons against]. Urologe A 2014; 53:840-6. [PMID: 24841423 DOI: 10.1007/s00120-014-3548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primarily treating metastatic malignancies systemically was an untouchable dogma for decades. Accordingly local therapy was reserved for localized disease only. However, in some oncological entities this apodictic principle could be disproved. In metastatic renal cell carcinoma cytoreductive nephrectomy is the current standard of care for appropriately selected patients but there is a lack of robust data for radical prostatectomy in patients with hematogenous spread from prostate cancer. Therefore, surgical treatment is not recommended outside clinical trials for the latter indication.
Collapse
Affiliation(s)
- J Huber
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
| | | | | |
Collapse
|