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Grössmann-Waniek N, Riegelnegg M, Gassner L, Wild C. Robot-assisted surgery in thoracic and visceral indications: an updated systematic review. Surg Endosc 2024; 38:1139-1150. [PMID: 38307958 PMCID: PMC10881599 DOI: 10.1007/s00464-023-10670-1] [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: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND In surgical advancements, robot-assisted surgery (RAS) holds several promises like shorter hospital stays, reduced complications, and improved technical capabilities over standard care. Despite extensive evidence, the actual patient benefits of RAS remain unclear. Thus, our systematic review aimed to assess the effectiveness and safety of RAS in visceral and thoracic surgery compared to laparoscopic or open surgery. METHODS We performed a systematic literature search in two databases (Medline via Ovid and The Cochrane Library) in April 2023. The search was restricted to 14 predefined thoracic and visceral procedures and randomized controlled trials (RCTs). Synthesis of data on critical outcomes followed the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and the risk of bias was evaluated using the Cochrane Collaboration's Tool Version 1. RESULTS For five out of 14 procedures, no evidence could be identified. A total of 20 RCTs and five follow-up publications met the inclusion criteria. Overall, most studies had either not reported or measured patient-relevant endpoints. The majority of outcomes showed comparable results between study groups. However, RAS demonstrated potential advantages in specific endpoints (e.g., blood loss), yet these findings relied on a limited number of low-quality studies. Statistically significant RAS benefits were also noted in some outcomes for certain indications-recurrence, quality of life, transfusions, and hospitalisation. Safety outcomes were improved for patients undergoing robot-assisted gastrectomy, as well as rectal and liver resection. Regarding operation time, results were contradicting. CONCLUSION In summary, conclusive assertions on RAS superiority are impeded by inconsistent and insufficient low-quality evidence across various outcomes and procedures. While RAS may offer potential advantages in some surgical areas, healthcare decisions should also take into account the limited quality of evidence, financial implications, and environmental factors. Furthermore, considerations should extend to the ergonomic aspects for maintaining a healthy surgical environment.
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Affiliation(s)
- Nicole Grössmann-Waniek
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Michaela Riegelnegg
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Lucia Gassner
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
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Gorard J, Boal M, Swamynathan V, Ghamrawi W, Francis N. The application of objective clinical human reliability analysis (OCHRA) in the assessment of basic robotic surgical skills. Surg Endosc 2024; 38:116-128. [PMID: 37932602 PMCID: PMC10776495 DOI: 10.1007/s00464-023-10510-2] [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: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Using a validated, objective, and standardised assessment tool to assess progression and competency is essential for basic robotic surgical training programmes. Objective clinical human reliability analysis (OCHRA) is an error-based assessment tool that provides in-depth analysis of individual technical errors. We conducted a feasibility study to assess the concurrent validity and reliability of OCHRA when applied to basic, generic robotic technical skills assessment. METHODS Selected basic robotic surgical skill tasks, in virtual reality (VR) and dry lab equivalent, were performed by novice robotic surgeons during an intensive 5-day robotic surgical skills course on da Vinci® X and Xi surgical systems. For each task, we described a hierarchical task analysis. Our developed robotic surgical-specific OCHRA methodology was applied to error events in recorded videos with a standardised definition. Statistical analysis to assess concurrent validity with existing tools and inter-rater reliability were performed. RESULTS OCHRA methodology was applied to 272 basic robotic surgical skills tasks performed by 20 novice robotic surgeons. Performance scores improved from the start of the course to the end using all three assessment tools; Global Evaluative Assessment of Robotic Skills (GEARS) [VR: t(19) = - 9.33, p < 0.001] [dry lab: t(19) = - 10.17, p < 0.001], OCHRA [VR: t(19) = 6.33, p < 0.001] [dry lab: t(19) = 10.69, p < 0.001] and automated VR [VR: t(19) = - 8.26, p < 0.001]. Correlation analysis, for OCHRA compared to GEARS and automated VR scores, shows a significant and strong inverse correlation in every VR and dry lab task; OCHRA vs GEARS [VR: mean r = - 0.78, p < 0.001] [dry lab: mean r = - 0.82, p < 0.001] and OCHRA vs automated VR [VR: mean r = - 0.77, p < 0.001]. There is very strong and significant inter-rater reliability between two independent reviewers (r = 0.926, p < 0.001). CONCLUSION OCHRA methodology provides a detailed error analysis tool in basic robotic surgical skills with high reliability and concurrent validity with existing tools. OCHRA requires further evaluation in more advanced robotic surgical procedures.
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Affiliation(s)
- Jack Gorard
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
| | - Matthew Boal
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Charles Bell House, University College London, London, UK
| | - Vishaal Swamynathan
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
| | - Walaa Ghamrawi
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK
| | - Nader Francis
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK.
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Jain Y, Lanjewar R, Shinde RK. Revolutionising Breast Surgery: A Comprehensive Review of Robotic Innovations in Breast Surgery and Reconstruction. Cureus 2024; 16:e52695. [PMID: 38384645 PMCID: PMC10879655 DOI: 10.7759/cureus.52695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Robotic innovations in breast surgery have ushered in a new era of precision, safety, and patient-centred care. This comprehensive review explores the multifaceted realm of robotic breast surgery, from preoperative planning to postoperative outcomes, learning curves for surgeons, and the implications for healthcare policies. We examine the ethical considerations, cost-effectiveness, and future directions, including integrating artificial intelligence and telesurgery. Key findings reveal that robotic systems provide improved surgical precision, reduced complications, and enhanced patient satisfaction. Ethical concerns encompass informed consent, resource allocation, and equitable access. The future of breast surgery lies in continued research and development, ensuring that robotics becomes a standard of care accessible to all patients. This technology is reshaping breast surgery and offering new possibilities for minimally invasive, patient-centred care, ultimately redefining the standards of care in this critical field of medicine.
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Affiliation(s)
- Yashraj Jain
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Lanjewar
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ballesta Martinez B, Kallidonis P, Tsaturyan A, Peteinaris A, Faitatziadis S, Gkeka K, Tatanis V, Vagionis A, Pagonis K, Obaidat M, Anaplioti E, Haney C, Vrettos T, Liatsikos E. Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study. Actas Urol Esp 2023; 47:611-617. [PMID: 37574013 DOI: 10.1016/j.acuroe.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. MATERIAL AND METHODS An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. RESULTS All procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. CONCLUSIONS Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.
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Affiliation(s)
- B Ballesta Martinez
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Hospital Vinalopó, Elche, Spain
| | - P Kallidonis
- Department of Urology, University of Patras, Patras, Greece
| | - A Tsaturyan
- Department of Urology, University of Patras, Patras, Greece
| | - A Peteinaris
- Department of Urology, University of Patras, Patras, Greece
| | - S Faitatziadis
- Department of Urology, University of Patras, Patras, Greece
| | - K Gkeka
- Department of Urology, University of Patras, Patras, Greece
| | - V Tatanis
- Department of Urology, University of Patras, Patras, Greece
| | - A Vagionis
- Department of Urology, University of Patras, Patras, Greece
| | - K Pagonis
- Department of Urology, University of Patras, Patras, Greece
| | - M Obaidat
- Department of Urology, University of Patras, Patras, Greece
| | - E Anaplioti
- Department of Urology, University of Patras, Patras, Greece
| | - C Haney
- Department of Urology, University Hospital of Leipzig, Leipzig, Germany
| | - T Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - E Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria.
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De Groote R, Puliatti S, Amato M, Mazzone E, Larcher A, Farinha R, Paludo A, Desender L, Hubert N, Cleynenbreugel BV, Bunting BP, Mottrie A, Gallagher AG, Rosiello G, Uvin P, Decoene J, Tuyten T, D’Hondt M, Chatzopoulos C, De Troyer B, Turri F, Dell’Oglio P, Liakos N, Andrea Bravi C, Lambert E, Andras I, Di Maida F, Everaerts W. Discrimination, Reliability, Sensitivity, and Specificity of Robotic Surgical Proficiency Assessment With Global Evaluative Assessment of Robotic Skills and Binary Scoring Metrics: Results From a Randomized Controlled Trial. ANNALS OF SURGERY OPEN 2023; 4:e307. [PMID: 37746611 PMCID: PMC10513364 DOI: 10.1097/as9.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/03/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity. Background GEARS-Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations. Methods In a prospective, randomized, and blinded study, we compared conventional with PBP training for a robotic suturing, knot-tying anastomosis task. Thirty-six surgical residents from 16 Belgium residency programs were randomized. In the skills laboratory, the PBP group trained until they demonstrated a quantitatively defined proficiency benchmark. The conventional group were yoked to the same training time but without the proficiency requirement. The final trial was video recorded and assessed with binary metrics and GEARS by robotic surgeons blinded to individual, group, and residency program. Sensitivity and specificity of the two assessment methods were evaluated with area under the curve (AUC) and receiver operating characteristics (ROC) curves. Results The PBP group made 42% fewer objectively assessed performance errors than the conventional group (P < 0.001) and scored 15% better on the GEARS assessment (P = 0.033). The mean interrater reliability for binary metrics and GEARS was 0.87 and 0.38, respectively. Binary total error metrics AUC was 97% and for GEARS 85%. With a sensitivity threshold of 0.8, false positives rates were 3% and 25% for, respectively, the binary and GEARS assessments. Conclusions Binary metrics for scoring a robotic VUA task demonstrated better psychometric properties than the GEARS assessment.
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Affiliation(s)
- Ruben De Groote
- From the ORSI Academy, Ghent, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Stefano Puliatti
- From the ORSI Academy, Ghent, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Amato
- From the ORSI Academy, Ghent, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Artur Paludo
- From the ORSI Academy, Ghent, Belgium
- Clinic Hospital of Porto Alegre, Urology, Porto Alegre, Brazil
| | - Liesbeth Desender
- Department of Thoracovascular Surgery, University Hospital Ghent, Ghent, Belgium
| | - Nicolas Hubert
- Department of Urology, CHR de la Citadelle, Liège, Belgium
| | | | - Brendan P. Bunting
- School of Psychology, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Alexandre Mottrie
- From the ORSI Academy, Ghent, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Anthony G. Gallagher
- From the ORSI Academy, Ghent, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - Giuseppe Rosiello
- From the ORSI Academy, Ghent, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pieter Uvin
- Department of Urology, AZ Sint-Jan, Bruges, Belgium
| | - Jasper Decoene
- Department of Urology, OLV van Lourdes Hospital, Waregem, Belgium
| | - Tom Tuyten
- Department of Urology, Jessa Hospital, Hasselt, Belgium
| | | | | | - Bart De Troyer
- Department of Urology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Filippo Turri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Carlo Andrea Bravi
- From the ORSI Academy, Ghent, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Wouter Everaerts
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Yim NH, Burns HR, Davis MJ, Selber JC. Robotic Plastic Surgery Education: Developing a Robotic Surgery Training Program Specific to Plastic Surgery Trainees. Semin Plast Surg 2023; 37:157-167. [PMID: 38444955 PMCID: PMC10911909 DOI: 10.1055/s-0043-1771026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Over the past two decades, the surgical community has increasingly embraced robotic-assisted surgery (RAS) due to its potential to enhance accuracy and decrease surgical morbidity. Plastic surgery as a field has been historically slow to incorporate RAS, with lack of adequate training posing as one of the most commonly cited barriers. To date, robot technology has been utilized for various reconstructive procedures including flap elevation and inset, pedicle dissection, and microvascular anastomosis. As RAS continues to integrate within plastic surgery procedures, the need for a structured RAS curriculum designed for plastic surgery trainees is rising. This article delineates the essential components of a plastic surgery-specific RAS curriculum and outlines current training models and assessment tools utilized across surgical subspecialties to date.
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Affiliation(s)
- Nicholas H. Yim
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Matthew J. Davis
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jesse C. Selber
- Department of Plastic Surgery, Corewell Health, Grand Rapids, Michigan
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De Cillis S, Geretto P, Phé V. Opening the Horizons of Functional Urology and Neurourology to Robot-assisted Surgery. Eur Urol 2023; 83:189-190. [PMID: 36609011 DOI: 10.1016/j.eururo.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/27/2022] [Accepted: 12/17/2022] [Indexed: 01/06/2023]
Abstract
Robot-assisted surgery is likely to become the new standard of care for functional urology and neurourology. It has the potential to fill the gap that has prevented the spread of laparoscopic surgery in these fields. With its many technical advantages, together with the potentially more efficient training of junior surgeons, robot-assisted surgery could finally bring more homogeneity to high-level surgical procedures in functional urology and neurourology worldwide.
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Affiliation(s)
- Sabrina De Cillis
- Department of Urology, Tenon Academic Hospital, Sorbonne University, AP-HP Paris, France; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
| | - Paolo Geretto
- Department of Urology, Tenon Academic Hospital, Sorbonne University, AP-HP Paris, France; Unit of Neuro-Urology, Orthopedic Trauma Center-Spinal Unit Hospital, Città Della Salute e Della Scienza, Turin, Italy
| | - Veronique Phé
- Department of Urology, Tenon Academic Hospital, Sorbonne University, AP-HP Paris, France
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Rahimi AM, Hardon SF, Willuth E, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, Horeman T, Nickel F, Daams F. Force-based assessment of tissue handling skills in simulation training for robot-assisted surgery. Surg Endosc 2023:10.1007/s00464-023-09905-y. [PMID: 36759353 DOI: 10.1007/s00464-023-09905-y] [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: 10/25/2022] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Although robotic-assisted surgery is increasingly performed, objective assessment of technical skills is lacking. The aim of this study is to provide validity evidence for objective assessment of technical skills for robotic-assisted surgery. METHODS An international multicenter study was conducted with participants from the academic hospitals Heidelberg University Hospital (Germany, Heidelberg) and the Amsterdam University Medical Centers (The Netherlands, Amsterdam). Trainees with distinctly different levels of robotic surgery experience were divided into three groups (novice, intermediate, expert) and enrolled in a training curriculum. Each trainee performed six trials of a standardized suturing task using the da Vinci Surgical System. Using the ForceSense system, five force-based parameters were analyzed, for objective assessment of tissue handling skills. Mann-Whitney U test and linear regression were used to analyze performance differences and the Wilcoxon signed-rank test to analyze skills progression. RESULTS A total of 360 trials, performed by 60 participants, were analyzed. Significant differences between the novices, intermediates and experts were observed regarding the total completion time (41 s vs 29 s vs 22 s p = 0.003), mean non zero force (29 N vs 33 N vs 19 N p = 0.032), maximum impulse (40 Ns vs 31 Ns vs 20 Ns p = 0.001) and force volume (38 N3 vs 32 N3 vs 22 N3 p = 0.018). Furthermore, the experts showed better results in mean non-zero force (22 N vs 13 N p = 0.015), maximum impulse (24 Ns vs 17 Ns p = 0.043) and force volume (25 N3 vs 16 N3 p = 0.025) compared to the intermediates (p ≤ 0.05). Lastly, learning curve improvement was observed for the total task completion time, mean non-zero force, maximum impulse and force volume (p ≤ 0.05). CONCLUSION Construct validity for force-based assessment of tissue handling skills in robot-assisted surgery is established. It is advised to incorporate objective assessment and feedback in robot-assisted surgery training programs to determine technical proficiency and, potentially, to prevent tissue trauma.
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Affiliation(s)
- A Masie Rahimi
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands. .,Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Sem F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Caelan M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Eleni A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Freek Daams
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands
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Endogenous stimuli-responsive nanoparticles for cancer therapy: From bench to bedside. Pharmacol Res 2022; 186:106522. [DOI: 10.1016/j.phrs.2022.106522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
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10
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Puliatti S, Amato M, Mazzone E, Rosiello G, De Groote R, Berquin C, Piazza P, Farinha R, Mottrie A, Gallagher AG. Development and Validation of the Metric-Based Assessment of a Robotic Dissection Task on an Avian Model. J Surg Res 2022; 277:224-234. [DOI: 10.1016/j.jss.2022.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 01/16/2023]
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Wijburg CJ, Hannink G, Michels CT, Weijerman PC, Issa R, Tay A, Decaestecker K, Wiklund P, Hosseini A, Sridhar A, Kelly J, d'Hondt F, Mottrie A, Klaver S, Edeling S, Dell'Oglio P, Montorsi F, Rovers MM, Witjes JA. Learning Curve Analysis for Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section Scientific Working Group. EUR UROL SUPPL 2022; 39:55-61. [PMID: 35528784 PMCID: PMC9068730 DOI: 10.1016/j.euros.2022.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background The utilisation of robot-assisted radical cystectomy with intracorporeal reconstruction (iRARC) has increased in recent years. Little is known about the length of the learning curve (LC) for this procedure. Objective To study the length of the LC for iRARC in terms of 90-d major complications (MC90; Clavien-Dindo grade ≥3), 90-d overall complications (OC90, Clavien-Dindo grades 1–5), operating time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). Design, setting, and participants This was a retrospective analysis of all consecutive iRARC cases from nine European high-volume hospitals with ≥100 cases. All patients had bladder cancer for which iRARC was performed, with an ileal conduit or neobladder as the urinary diversion. Outcome measurements and statistical analysis Outcome parameters used as a proxy for LC length were the number of consecutive cases needed to reach a plateau level in two-piece mixed-effects models for MC90, OC90, OT, EBL, and LOS. Results and limitations A total of 2186 patients undergoing iRARC between 2003 and 2018were included. The plateau levels for MC90 and OC90 were reached after 137 cases (95% confidence interval [CI] 80–193) and 97 cases (95% CI 41–154), respectively. The mean MC90 rate at the plateau was 14% (95% CI 7–21%). The plateau level was reached after 75 cases (95% CI 65–86) for OT, 88 cases (95% CI 70–106) for EBL, and 198 cases (95% CI 130–266) for LOS. A major limitation of the study is the difference in the balance of urinary diversion types between centres. Conclusions This multicentre retrospective analysis for the iRARC LC among nine European centres showed that 137 consecutive cases were needed to reach a stable MC90 rate. Patient summary We carried out a multicentre analysis of the surgical learning curve for robot-assisted removal of the bladder and bladder reconstruction in patients with bladder cancer. We found that 137 consecutive cases were needed to reach a stable rate of serious complications.
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12
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Migliorini F, Forte S, Rocco B, Kiely P, Mottrie A, Gallagher AG. Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study. Int J Comput Assist Radiol Surg 2022; 17:457-465. [PMID: 34997525 PMCID: PMC8740863 DOI: 10.1007/s11548-021-02545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
Purpose In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task.
Methods A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Results The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task. Conclusions PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills. Trial registration ClinicalTrials.gov Identifier: NCT04541615.
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Affiliation(s)
- Stefano Puliatti
- ORSI Academy, Melle, Belgium.
- Department of Urology, OLV, Aalst, Belgium.
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Urology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Marco Amato
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rui Farinha
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Artur Paludo
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giuseppe Rosiello
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Lorenzo Bianchi
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
- Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
| | | | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Migliorini
- Urology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Saverio Forte
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Bernardo Rocco
- Urology Department, ASST Santi Paolo e Carlo - Milano, Università Statale di Milano, Milan, Italy
| | - Patrick Kiely
- ORSI Academy, Melle, Belgium
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Anthony G Gallagher
- ORSI Academy, Melle, Belgium
- Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK
- Faculty of Medicine, KU Leuven, Leuven, Belgium
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13
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Farinha R, Puliatti S, Mazzone E, Amato M, Rosiello G, Yadav S, De Groote R, Piazza P, Bravi CA, Koukourikis P, Rha KH, Cacciamani G, Micali S, Wiklund P, Rocco B, Mottrie A. Potential Contenders for the Leadership in Robotic Surgery. J Endourol 2021; 36:317-326. [PMID: 34579555 DOI: 10.1089/end.2021.0321] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To summarize the scientific published literature on new robotic surgical platforms with potential use in the urological field, reviewing their evolution from presentation until the present day. Our goal is to describe the current characteristics and possible prospects for these platforms. Materials and Methods: A nonsystematic search of the PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases was conducted to identify scientific literature about new robotic platforms other than the Da Vinci® system, reviewing their evolution from inception until December 2020. Only English language publications were included. The following keywords were used: "new robotic platforms," "Revo-I robot," "Versius robot," and "Senhance robot." All relevant English-language original studies were analyzed by one author (R.F.) and summarized after discussion with an independent third party (E.M., S.Y., S.P., and M.A.). Results: Since 1995, Intuitive Surgical, Inc., with the Da Vinci surgical system, is the leading company in the robotic surgical market. However, Revo-I®, Versius®, and Senhance® are the other three platforms that recently appeared on the market with available articles published in peer-reviewed journals. Among these three new surgical systems, the Senhance robot has the most substantial scientific proof of its capacity to perform minimally invasive urological surgery and as such, it might become a contender of the Da Vinci robot. Conclusions: The Da Vinci surgical platform has allowed the diffusion of robotic surgery worldwide and showed the different advantages of this type of technique. However, its use has some drawbacks, especially its price. New robotic platforms characterized by unique features are under development. Of note, they might be less expensive compared with the Da Vinci robotic system. We found that these new platforms are still at the beginning of their technical and scientific validation. However, the Senhance robot is in a more advanced stage, with clinical studies supporting its full implementation.
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Affiliation(s)
- Rui Farinha
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Urology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Urology Department, Lusíadas Hospital, Lisbon, Portugal
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Amato
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Siddharth Yadav
- Department of Urology & Renal Transplant, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Andrea Bravi
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Periklis Koukourikis
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Second Department of Urology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Giovanni Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
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14
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Bonfante G, Puliatti S, Sighinolfi MC, Eissa A, Ciarlariello S, Ferrari R, Ticonosco M, Goezen AS, Guven S, Rassweiler J, Bianchi G, Rocco B, Micali S. A survey-based study on the spread of en-bloc resection of bladder tumors among IEA and ESUT members. Minerva Urol Nephrol 2021; 73:413-416. [PMID: 34494413 DOI: 10.23736/s2724-6051.21.04627-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giulia Bonfante
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouwe Hospital, Aalst, Belgium
| | - Maria C Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Silvia Ciarlariello
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ali Serdar Goezen
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Selcuk Guven
- Department of Urology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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15
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Development and validation of the metric-based assessment of a robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. J Robot Surg 2021; 16:677-685. [PMID: 34383208 DOI: 10.1007/s11701-021-01293-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
The evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26 min to complete the entire task on trial 1 and 20 min on trial 2. Experts took 10.1 min and 9.5 min. On average the Expert Group completed the task 137% faster than the Novice Group. The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26 min on trial 1 and 20 min on trial 2. Experts took 5.5 min and 4.8 min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94-upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.
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16
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Mazzone E, Puliatti S, Amato M, Bunting B, Rocco B, Montorsi F, Mottrie A, Gallagher AG. A Systematic Review and Meta-analysis on the Impact of Proficiency-based Progression Simulation Training on Performance Outcomes. Ann Surg 2021; 274:281-289. [PMID: 33630473 DOI: 10.1097/sla.0000000000004650] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyze all published prospective, randomized, and blinded clinical studies on the proficiency-based progression (PBP) training using objective performance metrics. BACKGROUND The benefit of PBP methodology to learning clinical skills in comparison to conventional training is not settled. METHODS Search of PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases, from inception to 1st March 2020. Two independent reviewers extracted the data. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess the methodological quality of included studies. Results were pooled using biased corrected standardized mean difference and ratio-of-means. Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. Secondary outcomes were the number of procedural steps completed and the time to complete the task/procedure. RESULTS From the initial pool of 468 studies, 12 randomized clinical studies with a total of 239 participants were included in the analysis. In comparison to the non-PBP training, ratio-of-means results showed that PBP training reduced the number of performance errors by 60% (P < 0.001) and procedural time by 15% (P = 0.003) and increased the number of steps performed by 47% (P < 0.001). CONCLUSIONS AND RELEVANCE Our systematic review and meta-analysis confirms that PBP training in comparison to conventional or quality assured training improved trainees' performances, by decreasing procedural errors and procedural time, while increasing the number of correct steps taken when compared to standard simulation-based training.
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Affiliation(s)
- Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
- ORSI Academy, Melle, Belgium
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Amato
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Brendan Bunting
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Northern Ireland, UK
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Anthony G Gallagher
- ORSI Academy, Melle, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Northern Ireland, UK
- Faculty of Medicine, KU Leuven, Leuven, Belgium
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17
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Mottrie A, Mazzone E, Wiklund P, Graefen M, Collins JW, De Groote R, Dell’Oglio P, Puliatti S, Gallagher AG. Objective assessment of intraoperative skills for robot-assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative. BJU Int 2021; 128:103-111. [PMID: 33251703 PMCID: PMC8359192 DOI: 10.1111/bju.15311] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To develop and seek consensus from procedure experts on the metrics that best characterise a reference robot-assisted radical prostatectomy (RARP) and determine if the metrics distinguished between the objectively assessed RARP performance of experienced and novice urologists, as identifying objective performance metrics for surgical training in robotic surgery is imperative for patient safety. MATERIALS AND METHODS In Study 1, the metrics, i.e. 12 phases of the procedure, 81 steps, 245 errors and 110 critical errors for a reference RARP were developed and then presented to an international Delphi panel of 19 experienced urologists. In Study 2, 12 very experienced surgeons (VES) who had performed >500 RARPs and 12 novice urology surgeons performed a RARP, which was video recorded and assessed by two experienced urologists blinded as to subject and group. Percentage agreement between experienced urologists for the Delphi meeting and Mann-Whitney U- and Kruskal-Wallis tests were used for construct validation of the newly identified RARP metrics. RESULTS At the Delphi panel, consensus was reached on the appropriateness of the metrics for a reference RARP. In Study 2, the results showed that the VES performed ~4% more procedure steps and made 72% fewer procedure errors than the novices (P = 0.027). Phases VIIa and VIIb (i.e. neurovascular bundle dissection) best discriminated between the VES and novices. LIMITATIONS VES whose performance was in the bottom half of their group demonstrated considerable error variability and made five-times as many errors as the other half of the group (P = 0.006). CONCLUSIONS The international Delphi panel reached high-level consensus on the RARP metrics that reliably distinguished between the objectively scored procedure performance of VES and novices. Reliable and valid performance metrics of RARP are imperative for effective and quality assured surgical training.
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Affiliation(s)
- Alexandre Mottrie
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
| | - Elio Mazzone
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
- Division of Oncology/Unit of UrologyURIL’Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San RaffaeleMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Peter Wiklund
- Department of UrologyKarolinska InstitutetStockholmSweden
- Department of UrologyIcahn School of Medicine at Mount Sinai Health SystemNew YorkNYUSA
| | - Markus Graefen
- Martini‐Klinik Prostate Cancer CenterUniversity Hospital Hamburg‐EppendorfHamburgGermany
| | - Justin W. Collins
- Orsi AcademyMelleBelgium
- Department of Uro‐oncologyUniversity College London Hospital (UCLH)LondonUK
| | - Ruben De Groote
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
| | - Paolo Dell’Oglio
- Orsi AcademyMelleBelgium
- Department of UrologyASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Stefano Puliatti
- Orsi AcademyMelleBelgium
- Department of UrologyOnze Lieve Vrouw Hospital (OLV)AalstBelgium
- Department of UrologyUniversity of Modena and Reggio EmiliaModenaItaly
| | - Anthony G. Gallagher
- Orsi AcademyMelleBelgium
- Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
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18
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Feizi N, Tavakoli M, Patel RV, Atashzar SF. Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision. Front Robot AI 2021; 8:610677. [PMID: 33937347 PMCID: PMC8079974 DOI: 10.3389/frobt.2021.610677] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022] Open
Abstract
The unprecedented shock caused by the COVID-19 pandemic has severely influenced the delivery of regular healthcare services. Most non-urgent medical activities, including elective surgeries, have been paused to mitigate the risk of infection and to dedicate medical resources to managing the pandemic. In this regard, not only surgeries are substantially influenced, but also pre- and post-operative assessment of patients and training for surgical procedures have been significantly impacted due to the pandemic. Many countries are planning a phased reopening, which includes the resumption of some surgical procedures. However, it is not clear how the reopening safe-practice guidelines will impact the quality of healthcare delivery. This perspective article evaluates the use of robotics and AI in 1) robotics-assisted surgery, 2) tele-examination of patients for pre- and post-surgery, and 3) tele-training for surgical procedures. Surgeons interact with a large number of staff and patients on a daily basis. Thus, the risk of infection transmission between them raises concerns. In addition, pre- and post-operative assessment also raises concerns about increasing the risk of disease transmission, in particular, since many patients may have other underlying conditions, which can increase their chances of mortality due to the virus. The pandemic has also limited the time and access that trainee surgeons have for training in the OR and/or in the presence of an expert. In this article, we describe existing challenges and possible solutions and suggest future research directions that may be relevant for robotics and AI in addressing the three tasks mentioned above.
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Affiliation(s)
- Navid Feizi
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, and School of Biomedical Engineering, University of Western Ontario, London, ON, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Rajni V. Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre, and School of Biomedical Engineering, University of Western Ontario, London, ON, Canada
- Department of Electrical and Computer Engineering, University of Western Ontario, London, ON, Canada
- Department of Surgery, University of Western Ontario, London, ON, Canada
| | - S. Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, United States
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
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19
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Amato M, Eissa A, Puliatti S, Secchi C, Ferraguti F, Minelli M, Meneghini A, Landi I, Guarino G, Sighinolfi MC, Rocco B, Bianchi G, Micali S. Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study. World J Urol 2021; 39:3465-3471. [PMID: 33538866 PMCID: PMC7859466 DOI: 10.1007/s00345-021-03594-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03594-9.
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Affiliation(s)
- Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Cristian Secchi
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federica Ferraguti
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Marco Minelli
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Isotta Landi
- Department of Psychology and Cognitive Sciences, University of Trento, Royereto, Italy
| | - Giulio Guarino
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
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Puliatti S, Mazzone E, Amato M, De Groote R, Mottrie A, Gallagher AG. Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model. Surg Endosc 2020; 35:4285-4294. [PMID: 32857241 DOI: 10.1007/s00464-020-07918-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery. OBJECTIVE To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model. DESIGN, SETTING AND PARTICIPANTS Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9-0.95). Novices took 18.5 min to complete the task and experts took 8.2 min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343). CONCLUSIONS We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.
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Affiliation(s)
- Stefano Puliatti
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Amato
- ORSI Academy, Melle, Belgium. .,Department of Urology, OLV, Aalst, Belgium. .,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, OLV, Aalst, Belgium
| | - Anthony G Gallagher
- ORSI Academy, Melle, Belgium.,Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK.,Faculty of Medicine, KU Leuven, Leuven, Belgium
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Abstract
PURPOSE OF REVIEW The goal of this paper was to identify areas of importance in modern urology education that are not currently emphasized in current urological curricula. RECENT FINDINGS We identified curricular deficits in robotic surgical simulation, transgender health, leadership, business management, and social media training. Few practicing urologists feel comfortable managing transgender-specific needs, and most training programs do not adequately address transgender health. Urology programs also do not sufficiently emphasize topics in leadership, business management, or appropriate social media usage. With respect to simulation, while it is currently included in the Accreditation Council for Graduate Medical Education (ACGME) program requirements, it is currently under-utilized for training in robotic surgery. It is important for urologists to receive adequate training for the modern practice landscape. Where knowledge gaps among early practicing urologists arise, programs should adapt their curricula to address them.
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Beulens AJW, Vaartjes L, Tilli S, Brinkman WM, Umari P, Puliatti S, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, Van der Poel HG, Bangma CH, Wagner C. Structured robot-assisted surgery training curriculum for residents in Urology and impact on future surgical activity. J Robot Surg 2020; 15:497-510. [PMID: 32772237 DOI: 10.1007/s11701-020-01134-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
To gain insight into the availability of training for robot assisted surgery (RAS) and the possibility to perform RAS during Dutch residency curriculum and to analyze the effects on surgical skills by the introduction of an advanced course in RAS for residents. A combination of a validated snap shot survey and a prospective cohort study. Structured advanced RAS training including virtual reality (VR) simulation, dry and wet lab facility at ORSI academy (Belgium). A snap-shot survey has been sent to all the residents and specialists in Urology graduated during the years 2017-2020 in Netherlands. Among residents, only last year residents (5th and 6th year) have been considered for the RAS training. Although most of the residents (88.2%) and young urologists (95%) were asked to follow a basic training or meet basic requirements before starting RAS, the requirements set by the educators were different from center to center. Some of them were required to attend only an online course on RAS, whereas others were asked to achieve threshold scores at VR simulator and participate in a standardized course at a training institute. The attendance to a structured advanced course in RAS showed a significant increase in surgical skills. Our study shows residents in urology are allowed to perform RAS during their residency though the criteria for starting RAS differ significantly amongst the teaching hospitals. To guarantee a basic level of skills and knowledge a structured, (multi-step) training and certification program for RAS should be implemented.
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Affiliation(s)
- A J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - L Vaartjes
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - S Tilli
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - W M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P Umari
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - S Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
- Orsi Academy, Melle, Belgium
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - E L Koldewijn
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - A J M Hendrikx
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - J P van Basten
- Department of Urology, Prosper Prostate Cancer Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J J G van Merriënboer
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - H G Van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C H Bangma
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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23
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Beulens AJW, Hashish YAF, Brinkman WM, Umari P, Puliatti S, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, Van der Poel HG, Bangma CH, Wagner C. Training novice robot surgeons: Proctoring provides same results as simulator-generated guidance. J Robot Surg 2020; 15:397-428. [PMID: 32651769 DOI: 10.1007/s11701-020-01118-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
To understand the influence of proctored guidance versus simulator generated guidance (SGG) on the acquisition dexterity skills in novice surgeons learning RAS (robot assisted surgery). Prospective non-blinded 3-arm randomised controlled trial (RTC). Exclusion criteria: previous experience in RAS or robotic surgery simulation. The participants were assigned to three different intervention groups and received a different form of guidance: (1) proctored guidance, (2) simulator generated guidance, (3) no guidance, during training on virtual reality (VR) simulator. All participants were asked to complete multiple questionnaires. The training was the same in all groups with the exception of the intervention part. Catharina Hospital Eindhoven, The Netherlands. A total of 70 Dutch medical students, PhD-students, and surgical residents were included in the study. The participants were randomly assigned to one of the three groups. Overall, all the participants showed a significant improvement in their dexterity skills after the training. There was no significant difference in the improvement of surgical skills between the three different intervention groups. The proctored guidance group reported a higher participant satisfaction compared to the simulator-generated guidance group, which could indicate a higher motivation to continue the training. This study showed that novice surgeons. Significantly increase their dexterity skills in RAS after a short time of practicing on simulator. The lack of difference in results between the intervention groups could indicate there is a limited impact of "human proctoring" on dexterity skills during surgical simulation training. Since there is no difference between the intervention groups the exposure alone of novice surgeons to the robotic surgery simulator could possibly be sufficient to achieve a significant improvement of dexterity skills during the initial steps of RAS learning.
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Affiliation(s)
- A J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. .,Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Y A F Hashish
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - W M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P Umari
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - S Puliatti
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,Orsi Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - E L Koldewijn
- Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - A J M Hendrikx
- Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - J P van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J J G van Merriënboer
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - H G Van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C H Bangma
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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