1
|
Ma W, Gao H, Chang M, Lu Z, Li D, Ding C, Bi D, Sun F. The construction of a nomogram to predict the prognosis and recurrence risks of UPJO. Front Pediatr 2024; 12:1376196. [PMID: 38633323 PMCID: PMC11022601 DOI: 10.3389/fped.2024.1376196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Objective This study was conducted to explore the risk factors for the prognosis and recurrence of ureteropelvic junction obstruction (UPJO). Methods The correlation of these variables with the prognosis and recurrence risks was analyzed by binary and multivariate logistic regression. Besides, a nomogram was constructed based on the multivariate logistic regression calculation. After the model was verified by the C-statistic, the ROC curve was plotted to evaluate the sensitivity of the model. Finally, the decision curve analysis (DCA) was conducted to estimate the clinical benefits and losses of intervention measures under a series of risk thresholds. Results Preoperative automated peritoneal dialysis (APD), preoperative urinary tract infection (UTI), preoperative renal parenchymal thickness (RPT), Mayo adhesive probability (MAP) score, and surgeon proficiency were the high-risk factors for the prognosis and recurrence of UPJO. In addition, a nomogram was constructed based on the above 5 variables. The area under the curve (AUC) was 0.8831 after self cross-validation, which validated that the specificity of the model was favorable. Conclusion The column chart constructed by five factors has good predictive ability for the prognosis and recurrence of UPJO, which may provide more reasonable guidance for the clinical diagnosis and treatment of this disease.
Collapse
Affiliation(s)
- Wenyue Ma
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hongjie Gao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Mengmeng Chang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhiyi Lu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ding Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chen Ding
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Dan Bi
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fengyin Sun
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| |
Collapse
|
2
|
Zhou L, Huang J, Xie H, Chen F. The learning curve of robot-assisted laparoscopic pyeloplasty in children. J Robot Surg 2024; 18:97. [PMID: 38413450 DOI: 10.1007/s11701-024-01856-3] [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: 12/23/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
To explore the learning curve of robot-assisted laparoscopic pyeloplasty (RALP) in children. The clinical data, surgical information, and postoperative complications of consecutive cases of RALP performed by the same surgeon in Shanghai Children's Hospital from January 2014 to July 2020 were retrospectively analyzed; the surgeon is a senior pediatric urologists who is proficient in laparoscopic pyeloplasty; the data consist of console time (CT), suture method when anastomosing ureteropelvic junction (UPJ), number of stitches (N), anastomosis time per stitch (tn), the average suture time per stitch (T) = (suture time of first stitch (t1) + second stitch (t2) + … + tn)/N, postoperative complications, and surgical outcome. The learning curve was depicted by cumulative sum method (CUSUM) and validated by cumulative method (CUM). Of the 88 cases, 64 cases were included in present study. Median CT was 104 (83-117) min, mean T was 109 ± 17 s. There were ten cases of Clavien-Dindo Grade I complication and two cases of Clavien-Dindo Grade IIIb complication. The median follow-up time was 237 (87-627) days. The learning curve of CT has three stages, with inflection points at 11th and 57th case, and T has two stages, with inflection points at 19th case. There was a statistically significant difference between the console time and length of stay on both sides of the inflection point (P < 0.05), but there was no statistically significant difference in age, gender, etiology, clinical manifestation, surgical outcome, and complication (P > 0.05). For a senior pediatric urologists who is proficient in laparoscopic pyeloplasty, the learning curve of RALP can be divided into three stages, preliminary exploration stage, mastery stage, and proficiency stage. It takes about 11 cases to achieve the mastery stage, and it takes about 57 cases to achieve the proficiency stage. The learning curve focused on the suture technique of the surgeon is divided into two stages, and after a learning period of 19 cases, it will reach the proficiency stage of suturing UPJ.
Collapse
Affiliation(s)
- Lijun Zhou
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Jin Huang
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, 200135, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China.
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| |
Collapse
|
3
|
Kallidonis P, Tatanis V, Peteinaris A, Katsakiori P, Gkeka K, Faitatziadis S, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system. World J Urol 2023; 41:3155-3160. [PMID: 37668715 DOI: 10.1007/s00345-023-04586-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE This pilot study was designed to interpret the technically specific features of the avatera robotic system and present our initial experience with this novel platform in robot-assisted pyeloplasty (RAP). METHODS A single-center prospective study was conducted including all patients who underwent RAP with the avatera robotic system from June 2022 to October 2022 in our Department. Transperitoneal robot-assisted dismembered pyeloplasty was performed in all cases. The trocar placement and the surgical technique were similar in all patients. The successful completion of the procedures, operation time (including draping, docking and console time), decrease in hemoglobin postoperatively, and presence of any complications were the study's primary endpoints. RESULTS In total, nine patients underwent RAP using the avatera system. All procedures were successfully completed. The draping of the robotic unit was completed in a median time of 10 min (range 7-15), while the median docking time was 17 min (range 10-24). The median console time was 88 min (range 78-116) and no complications were noticed. The median hemoglobin drop was calculated to 0.7 g/dL (range 0.4-1). During the mean follow-up of 9.33 ± 2.78 months, no late postoperative complications were noticed. CONCLUSION The early outcomes of the use of the novel avatera system in RAP are presented. All operations were successfully completed with safety and efficacy, without complications or significant blood loss.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.
- Department of Urology, Medical University of Vienna, Vienna, Austria.
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
| |
Collapse
|
4
|
Gorgen ARH, Abreu FJDS, Paludo ADO, Menegolla MP, de Oliveira RT, Tavares PM, Rosito TE. Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume. Int Braz J Urol 2023; 49:462-468. [PMID: 37267611 PMCID: PMC10482452 DOI: 10.1590/s1677-5538.ibju.2023.0021] [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: 01/16/2023] [Accepted: 05/05/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. MATERIAL AND METHODS A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. RESULTS There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. CONCLUSION A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.
Collapse
Affiliation(s)
- Antonio Rebello Horta Gorgen
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- University of CaliforniaDepartment of UrologyIrvineCAUSADepartment of Urology, University of California Irvine, CA, USA;
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
| | - Fernando Jahn da Silva Abreu
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
| | - Artur de Oliveira Paludo
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Mauricio Picolo Menegolla
- Hospital de Clínicas de Porto AlegreServiço de Cirurgia GeralPorto AlegreRSBrasilServiço de Cirurgia Geral, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil;
| | - Renan Timóteo de Oliveira
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
| | - Patric Machado Tavares
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Tiago Elias Rosito
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
- Universidade Federal do Rio Grande do SulFaculdade de MedicinaPorto AlegreRSBrasilFaculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| |
Collapse
|
5
|
Checcucci E, De Cillis S, Amparore D, Gabriele V, Piramide F, Piana A, Fiori C, Piazzolla P, Porpiglia F. Artificial Intelligence Alert Systems during robotic surgery: a new potential tool to improve the safety of the intervention. UROLOGY VIDEO JOURNAL 2023. [DOI: 10.1016/j.urolvj.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
6
|
Madadi-Sanjani O, Brendel J, Kuebler JF, Ure BM. Definition, Documentation, and Classification of Complications in Pediatric Surgical Literature-A Plea for Standardization. Eur J Pediatr Surg 2023; 33:105-113. [PMID: 36720251 DOI: 10.1055/s-0043-1760835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Severity grading systems for complications in surgical patients have been used since 1992. An increasing assessment of these instruments in pediatric surgery is also noticed, without their validation in children. To analyze the current practice, we performed a literature review with focus on the assessment and grading of complications. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting on postoperative complications as a primary or secondary endpoint using a severity grading system were included. Definition for simple adverse events, classification systems used, and the time horizon of postoperative documentation were analyzed. A total of 566 articles were screened, of which 36 met the inclusion criteria. About 86.1% of the papers were retrospective and 13.9% prospective analyses. None of the studies were prospective-randomized trials. Twenty (55.6%) studies did not include a definition of adverse events, whereas the remaining 16 (44.4%) showed variations in their definitions. All studies applied the Clavien-Dindo classification, whereas five (13.9%) additionally used the Comprehensive Complication Index. One study compared alternative grading instruments with the Clavien-Dindo classification, without demonstrating the superiority of any classification in pediatric surgery. Twenty-two studies (61.1%) did not report the time horizon of perioperative complication documentation, while 8 studies (22.2%) used 30 days and 6 studies (16.7%) used 3 months of postoperative documentation. Definition and classification of postoperative complications are inconsistent in the pediatric surgical literature. Establishment of a standardized protocol is mandatory to accurately compare outcome data.
Collapse
Affiliation(s)
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
7
|
The Availability, Cost, Limitations, Learning Curve and Future of Robotic Systems in Urology and Prostate Cancer Surgery. J Clin Med 2023; 12:jcm12062268. [PMID: 36983269 PMCID: PMC10053304 DOI: 10.3390/jcm12062268] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Robot-assisted surgical systems (RASS) have revolutionised the management of many urological conditions over the last two decades with robot-assisted radical prostatectomy (RARP) now being considered by many to be the preferred surgical approach. Intuitive Surgical has dominated the market during this time period with successive iterations of the da Vinci model. The expiration of patents has opened the RASS market and several new contenders have become available or are currently in development. This comprehensive narrative review aims to explore the merits of each robotic system as well as the evidence and barriers to their use. The newly developed RASS have increased the versality of robotic surgical systems to a wider range of settings through advancement in technology. The increased competition may result in an overall reduction in cost, broadening the accessibility of RASS. Learning curves and training remain a barrier to their use, but the situation appears to be improving through dedicated training programmes. Outcomes for RARP have been well investigated and tend to support improved early functional outcomes. Overall, the rapid developments in the field of robot-assisted surgery indicate the beginning of a promising new era to further enhance urological surgery.
Collapse
|
8
|
Esposito C, Cerulo M, Lepore B, Coppola V, D'Auria D, Esposito G, Carulli R, Del Conte F, Escolino M. Robotic-assisted pyeloplasty in children: a systematic review of the literature. J Robot Surg 2023:10.1007/s11701-023-01559-1. [PMID: 36913057 PMCID: PMC10374693 DOI: 10.1007/s11701-023-01559-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023]
Abstract
Robotic pyeloplasty has become a natural progression from the development of open, then laparoscopic procedures to treat pediatric patients with ureteropelvic junction obstruction (UPJO). Robotic-assisted pyeloplasty (RALP) is now considered a new gold standard in pediatric MIS. A systematic review of the literature retrieved from PubMed and published in the last 10 years (2012-2022) was performed. This review underlines that in all children except the smallest infants, where the open procedure has benefits in terms of duration of general anesthetic and there are limitations in the size of instruments, robotic pyeloplasty is becoming the preferred procedure to perform in patients with UPJO. Results for the robotic approach are extremely promising, with shorter operative times than laparoscopy and equal success rates, length of stay and complications. In case of redo pyeloplasty, RALP is easier to perform than other open or MIS procedures. By 2009, robotic surgery became the most used modality to treat all UPJO and continues to grow in popularity. Robot-assisted laparoscopic pyeloplasty in children is safe and effective with excellent outcomes, even in redo pyeloplasty or challenging anatomical cases. Moreover, robotic approach shortens the learning curve for junior surgeons, who can readily achieve levels of expertise comparable to senior practitioners. However, there are still concerns regarding the cost associated with this procedure. Further high-quality prospective observational studies and clinical trials, as well as new technologies specific for the pediatric population, are advisable for RALP to reach the level of gold standard.
Collapse
Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy.
| | - Mariapina Cerulo
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Benedetta Lepore
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Coppola
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Daniela D'Auria
- Faculty of Computer Science, Free University of Bolzano, Bolzano, Italy
| | - Giorgia Esposito
- Internal Medicine Unit, University of Naples "Federico II", Naples, Italy
| | - Roberto Carulli
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Fulvia Del Conte
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, "Federico II" University of Naples School of Medicine, Via S. Pansini 5, 80131, Naples, Italy
| |
Collapse
|
9
|
Peteinaris A, Kallidonis P, Tsaturyan A, Pagonis K, Faitatziadis S, Gkeka K, Vagionis A, Natsos A, Obaidat M, Anaplioti E, Tatanis V, Vrettos T, Liatsikos E. The feasibility of robot-assisted radical cystectomy: an experimental study. World J Urol 2023; 41:477-482. [PMID: 36577927 DOI: 10.1007/s00345-022-04266-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To investigate the feasibility of the avatera system for performing robot-assisted radical cystectomy (RARC) followed by intracorporeal reconstruction of ileal neobladder. METHODS Six anesthetized female pigs were used to perform RARC and formation of the intracorporeal orthotopic ileal neobladder. Three surgeons with different level of expertise in the use of robotic systems performed RARC after a short instructional lecture and a 2-h hands-on training. The urinary diversion phase was performed only by the experienced surgeon. The successful completion of the procedure, operative time for demolitive and reconstructive phases, intraoperative blood loss and malfunction of the robotic system were evaluated. RESULTS An improvement of the operative time was observed for each surgeon. The experienced surgeon, the fellow and the resident improved their time by 11, 15, and 22 min, respectively, between the first and the second RARC performed. The most significant time difference was demonstrated by the resident, who had no previous experience in using robotic systems. The time difference between the first and the last orthotopic ileal neobladder creation for the experienced surgeon was 51 min. CONCLUSION The feasibility of avatera system for performing complex surgical procedure such as RARC with intracorporeal neobladder formation was demonstrated by this experimental study. No major bleeding or severe malfunctions were observed during the procedures. Significant improvement in operative time was demonstrated with the increasing experience from 1st to 6th case.
Collapse
Affiliation(s)
- Angelis Peteinaris
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Solon Faitatziadis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Kristiana Gkeka
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Mohammed Obaidat
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Eirini Anaplioti
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
10
|
Zhang KJ, Zhou H, Guo H, Li W, Yang Z, Liu R, Qin S, Xie X, Tian J. Learning and Short-Term Retention of Simulation-Based Arthroscopic Skills. JOURNAL OF SURGICAL EDUCATION 2023; 80:119-126. [PMID: 36137894 DOI: 10.1016/j.jsurg.2022.08.020] [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: 04/02/2022] [Revised: 07/09/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study aimed to examine the learning curve and short-term retention of arthroscopic skills acquired on a simulator. DESIGN Cohort study. SETTING Clinical Skills Training Center of Zhujiang Hospital of Southern Medical University PARTICIPANT AND METHODS: Orthopaedic residents (n = 14) without previous arthroscopy experience were included. After basic information was collected and an initial arthroscopy knowledge level test was administered, the subjects received standardised training on the simulator (day 1); then, they completed tasks on the simulator, including guided diagnostics (4 times), triangulation (5 times) and loose body removal (7 times). A learning curve for each skill was generated based on the total scores. The score of the last repetition of each task was the training level. RESULTS A total of 14 orthopedic residents were enrolled. All participants completed the training and testing. There was a learning curve over the course of training for all 3 arthroscopic skills (p < 0.001). On day 8 after the training, the mean score for guided diagnostics decreased from 49.9 to 48.9 (p = 0.001), and the retention rate was 97.8%. For triangulation, the mean total score decreased from 58.9 to 53.6 (p < 0.001), and the retention rate was 90.8%. For loose body removal, the mean total score decreased from 87.1 to 80.7 (p < 0.001), and the retention rate was 92.7%. CONCLUSIONS Orthopaedic residents' arthroscopic skills learned through simulator training declined significantly in 1 week after the training, especially more difficult skills.
Collapse
Affiliation(s)
- Kai-Jun Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haixia Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haopeng Guo
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhouwen Yang
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rubing Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shanlu Qin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaobo Xie
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Tian
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
11
|
Pakkasjärvi N, Krishnan N, Ripatti L, Anand S. Learning Curves in Pediatric Robot-Assisted Pyeloplasty: A Systematic Review. J Clin Med 2022; 11:6935. [PMID: 36498510 PMCID: PMC9737296 DOI: 10.3390/jcm11236935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Robot-assisted surgery demands a specific skillset of surgical knowledge, skills, and attitudes from the robotic surgeon to function as part of the robotic team and for maximal utility of the assistive surgical robot. Subsequently, the learning process of robot-assisted surgery entails new modes of learning. We sought to systematically summarize the published data on pediatric robot-assisted pyeloplasty (pRALP) to decipher the learning process by analyzing learning curves. Methods: This review followed the PRISMA guidelines. PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched for ‘learning curve’ AND ‘pediatric pyeloplasty’. All studies presenting outcomes of learning curves (LC) in the context of pRALP in patients < 18 years of age were included. Studies comparing LC in pRALP versus open and/or laparoscopic pyeloplasty were also included; however, those solely focusing on LC in non-robotic approaches were excluded. The methodological quality was assessed using the Newcastle and Ottawa scale. Results: Competency was non-uniformly defined in all fifteen studies addressing learning curves in pRALP. pRALP was considered safe at all stages. Proficiency in pRALP was reached after 18 cases, while competency was estimated to demand 31 operated cases with operative duration as outcome variable. Conclusions: Pediatric RALP is safe during the learning process and ‘learning by doing’ improves efficiency. Competencies with broader implications than time must be defined for future studies.
Collapse
Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, Turku University Hospital, 20521 Turku, Finland
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital, 20521 Turku, Finland
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
12
|
Partezani AD, Duarte-Santos HO, Amaral BS, Gomes Barbosa AR, Apezzato M, Brunhara J, Bianco B, Lemos GC, Carneiro A. Outcomes of nephrectomy for renal cell carcinoma: An ecologic retrospective study in a middle-income country. Arch Ital Urol Androl 2022; 94:129-133. [PMID: 35775333 DOI: 10.4081/aiua.2022.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe and compare the outcomes and indirect costs of oncological radical (RN) and partial nephrectomies (PN) in hospitals from the São Paulo public health system, Brazil. MATERIALS AND METHODS An ecologic retrospective study was performed from 2008 to 2019, using the TabNet Platform of the Brazilian Unified Health System Department of Informatics. Hospitals were classified according to volume of surgeries (low and high-volume, and also into four quartiles according to volume of surgeries), and with or without medical residency program in urology. The results were compared between groups. RESULTS In the period analyzed were performed 2.606 RN in 16 hospitals. Data available for PN ranged only from 2013-2019 and included 1.223 surgeries comprising 15 hospitals. Overall mortality rates were 0.41% for PN and 2.87% for RN. The length of hospital stay was significantly higher in low-volume hospitals for both RN and PN (8.97 vs. 5.62 days, p = 0.001, and 7.75 vs. 4.37 days, p = 0.001, respectively), and also for the RN in hospitals without residency program in Urology (9.37 vs. 6.54 days, p = 0.03). When the volume of surgeries was divided into four quartiles, the length of hospital stay and ICU hospitalization days were significantly higher in the first quartile hospitals for RN (p = 0.016) and PN (p = 0.009), respectively. The mortality rates and indirect costs were not different considering PN and RN in the different types of hospitals. CONCLUSIONS The length of hospital stay was significantly lower for both PN and RN in high-volume hospitals, and also for RN in hospitals with residency program in Urology.
Collapse
Affiliation(s)
| | | | | | | | - Marcelo Apezzato
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | - João Brunhara
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | - Bianca Bianco
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | | | - Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| |
Collapse
|